OPP Exam 2 Flashcards
Where do ribs articulate? (general)
Anteriorly with sternum, posteriorly with vertebral column
What are the functions of the thoracic cage?
nRespiration<br></br>nProtection of vital organs<br></br>nPump for venous and lymphatic return<br></br>nSupport structure for the upper extremities
“What is the rule of 3’s of the spinous processes?”
“1-3: SP of each is about the same horizontal plane as the TP of each vertebra<br></br><br></br>4-6: SP project slightly downward; the tip of the SP lies in a plane halfway between that vertebra’s TP and the TP of the vertebra below it<br></br><br></br>7-9: SP project moderately downward; the tip of the SP is in a plane with the TP of the vertebra below it<br></br><br></br>10-12: have SP that project from a position similar to T9 and rapidly regress until the orientation of the SP of T12 is similar to that of T1.”
Which part of the vertebral column will have limited motion?
Upper thoracic vertebrae: limited in motion due to anterior attachment of the ribs (unlike floating ribs which allow more motion)
What are the true ribs, and where do they attach?
True ribs: 1-7<br></br>Attach directly to the sternum via costochondral cartilage<br></br><br></br>have catilaginous attachment to sternum!!
What are the false ribs and where do they attach?
False ribs: 8-12<br></br><br></br>Ribs 8-10 attach via a synchondroses to the costochondral cartilage of rib 7
What are the floating ribs?
Floating (subclass false): 11-12<br></br><br></br>Do not attach to the sternum at all
What are the typical and atypical ribs?
nTypical: ribs 3-9 (10)<br></br><br></br>nAtypical: ribs 1, 2, (10), 11, 12
What is unique about rib 1?
”- articulates T1 - head of rib on body<br></br>- no angle<div><br></br></div><div><img></img></div>”
What is unique about rib 2?
“large tuberosity on shaft for serratus anterior<div><br></br></div><div><img></img></div>”
What is unique about ribs 11 and 12?
“articulates with vertebrae only<br></br>no tubercles<div><br></br></div><div><img></img></div>”
What anatomical landmarks are found on typical ribs (3-10)?
”- tubercle<br></br>- head<br></br>- neck<br></br>- angle<br></br>- shaft<div><br></br></div><div><img></img></div>”
What is contained within the costal groove?
intercostal vein, artery, and nerve <br></br><br></br>insert needle on superior aspect to avoid these structures
Where will T1, T11, and T12 articulate with ribs?
head of ribs only articulate with body
What are the costochondral articullations seen in the ribs?
Rib 1<br></br>Synchondrosis (non-synovial)<br></br><br></br>Ribs 2-7<br></br>Synovial articulations
What is costochondritis?
inflammation of cartilage that connects ribs
What nerve is at risk with an increased first rib?
lower brachial plexus: ulnar nerve <br></br><br></br>will affect 4th and 5th digits
List a clinical way that the brachial plexus may become impinged
patient with respiratory problems that uses anterior/middle scalene as accessory respiratory muscle: muscles can hypertrophy and compress brachial plexus
“What is Sibson’s fascia?”
a thickened area of endothoracic fascia at the apex of the lung<br></br><br></br>lymph vessel travels through this fascia!!!
“What can result from tension in sibson’s fascia?”
can compress lymphatic vessels that pierce the layer: alters flow of fluid in the body
What are the borders of the thoracic inlet?
first rib, vertebral body, sternum
What motions are seen in rib 1?
50/50 bucket and pump handle motion: anterior scalenes (anterior) pump handle, middle scalenes (lateral) bucket handle
What is the motion at ribs 1-7 costotransverse joints?
rotates
What is the motion at ribs 8-10 costotransverse joints?
glides
What is the motion at ribs 11, 12 costotransverse joints?
do not articulate with transverse process
What ribs display pump-handle motion?
ribs 2-5
What ribs display bucket-handle motion?
ribs 6-10
What ribs display caliper motion?
11 and 12
What ribs will show all 3 motions?
4-6
Where are pump-handle ribs best palpated for motion?
mid-clavicular line
Describe pump-handle motion
”- move anterior and superior with inhalation <br></br>- motion predominantly in sagittal plane<br></br>- best palpated at mid-clavicular line<br></br>- axis of motion is costovertebral-costotransverse line<div><br></br></div><div><img></img></div>”
Describe pump handle motion in inhalation and exhalation
“increases AP diameter<br></br><br></br>inhalation - anterior rib moves cephalad (superiorly), posterior rib moves caudad (inferiorly)<br></br><br></br>exhalation - opposite of inhalation<div><br></br></div><div><img></img></div>”
Where are bucket handle motion ribs best palpated?
mid-axillary line
Describe bucket handle motion
“(ribs 6-10)<br></br><br></br>- ribs move laterally and increase transverse diameter with inhalation<br></br>- motion predominantly in coronal plane<br></br>- best palpated at mid-axillary line<br></br>- axis of motion is costovertebral-costosternal line<div><br></br></div><div><img></img></div>”
What diameter is increased with bucket handle motion?
“transverse diameter of rib cage<br></br><br></br>rib shaft is the handle of the bucket<br></br>rib shaft lifts during inhalation, falls with exhalation<div><br></br></div><div><img></img></div>”
Where are caliper motion ribs best palpated?
3-5 cm lateral to TP
Describe caliper motion
“(ribs 11-12)<br></br><br></br>ribs externally rotate with inhalation<br></br>motion predominantly in transverse plane<br></br>best palpated 3-5 cm lateral to transverse processes<br></br>axis of motion is vertical line<div><br></br></div><div><img></img></div>”
What are the principal muscles for rib elevation
“diaphragm <br></br>external intercostals<br></br>interchondral internal intercostals<div><br></br></div><div><img></img></div>”
What are the anterior accessory muscles for rib elevation?
“SCM<br></br>anterior-middle scalene <br></br>posterior scalene<br></br>serratus anterior (inferior fibers)<div><br></br></div><div><img></img></div>”
What are the posterior accessory muscles for rib elevation?
serratus posterior superior <br></br>levatores costarum
What muscle is accessory for rib elevation during forced inspiration?
“pec minor<div><br></br></div><div><img></img></div>”
What muscles are responsible for rib depression during quiet breathing?
“1. passive recoil from lungs<br></br>2. diaphragm relaxation<div><br></br></div><div><img></img></div>”
What muscles are involved in rib depression during active breathing?
“1. internal, innermost intercostals <br></br>2. abdominal muscles (rectus abdominus, ext/int obliques, transversus abdominus)<div><br></br></div><div><img></img></div>”
What are the accessory muscles of rib depression
- serratus posterior inferior (stabilizes ribs against upward pull of diaphragm)<br></br>2. ext/internal obliques, transversus abdominus <br></br>3. transversus thoracis
How is rib somatic dysfunction named?
based on dynamic findings
Where is the key rib normally found in inhalation somatic dysfunction?
“lower <br></br><br></br>BITE: bottom inhalation, top exhalation<br></br><br></br>elevates with inspiration (ease)<br></br>"”stuck in”” inhalation<br></br>exhalation restriction - won’t move inferior with expiration<div><br></br></div><div><img></img></div>”
Where is the key rib normally found in exhalation somatic dysfunction?
“upper <br></br><br></br>BITE<br></br><br></br>moves inferiorly with expiration (ease)<br></br>"”stuck in”” exhalation<br></br>inhalation restriction<br></br>won’t move superior with inspiration<div><br></br></div><div><img></img></div>”
What is a viscerosomatic reflex?
“A reflex in which disruption, irritation, or disease of an internal organ results in reflex dysfunction of a segmentally related musculoskeletal region. Reflex is mediated from autonomic to somatic nerves.<div><br></br></div><div><img></img></div>”
Who verified existence of viscerosomatic reflexes?
I.M. Korr Ph.D
define chapman reflexes
Anterior and posterior tender points that may result from viscerosomatic reflexes. Initially, these were studied and used clinically by Frank Chapman, DO in the early 1900s.
What are the clinical uses of viscerosomatic reflexes?
“correlate with patient’s history and PE<br></br><br></br>can use to monitor progress”
What is rib raising?
influences ribcage mechanics to enhance venous and lymphatic flow and respiratory exchange
How do you perform rib raising?
”- patient supine<br></br>- physician at side of table<br></br>- hands under patient with finger pads ““hooking”” the rib angles<br></br>- exert a ventral and lateral force perpendicular to the paraspinal muscles <br></br>- use the forearm as a fulcrum - downward pressure of the forearm = ventral force through the hands <br></br>- may hold and wait for a release or …<br></br>- move up and down the thoracic spine in a gentle, rhythmic, kneading fashion <br></br>- reassess tissue tension<div><br></br></div><div><img></img></div>”
What are the 3 planes of motion?
“coronal, sagittal, horizontal<div><br></br></div><div><img></img></div>”
What are the 3 axis?
AP (anterior-posterior)<br></br><br></br>Transverse<br></br><br></br>Vertical
What movement occurs in the coronal plane?
”- transects AP<br></br>- side bending! (around an AP axis)<div><br></br></div><div><img></img></div>”
What movement occurs in the sagittal plane?
”- transects left and right<br></br>- flexion and extension (around a transverse axis)<div><br></br></div><div><img></img></div>”
What movement occurs in the transverse plane?
”- transects superior/inferior<br></br>- rotation occurs (around vertical axis)<div><br></br></div><div><img></img></div>”
What is the function of the anterior segment of vertebrae?
”- support<br></br>- weight bearing<br></br>- shock absorbing<br></br>- protection of the spinal cord<div><br></br></div><div><img></img></div>”
What is the tripod arrangement of the vertebrae?
”- anterior: column contains the vertebral bodies and the IV discs<br></br><br></br>- posterior: column contains the rest; the TPs and SPs<div><br></br></div><div><img></img></div>”
What is the function of the posterior segment of vertebrae?
”- directs joint motion<br></br>- protects spinal cord<br></br>- almost non-weight bearing the upright position<div><br></br></div><div><img></img></div>”
What are the properties of the anterior column?
“<div><img></img></div>”
What are the properties of the posterior column?
“<div><img></img></div>”
What are some structures that limit motion of the spinal column?
- ligaments<br></br>- muscular attachments<br></br>- osteology (shape of vertebrae and facets)<br></br>- IV discs<br></br>- disease causing structural changes
What is flexion and extension?
”- flexion is anterior approximation<br></br>- extension is anterior separation<div><br></br></div><div><img></img></div>”
What is rotation right and left?
”- turning the <b>anterior</b> aspect of the body to the right<br></br>- <b>turning the anterior aspect of the body to the left respectively</b><div><br></br></div><div><img></img></div>”
What is side bending?
“upper vertebral body approximates the one below it<div><br></br></div><div><img></img></div>”
Who is Fryette?
”- 1918 <br></br>- Harrison Fryette presented a paper<br></br>- described vertebral motions<br></br>- developed principles to follow<div><br></br></div><div><img></img></div>”
“What is Fryette’s first law?”
“When any part of the lumbar or thoracic spine is in neutral position, side bending of a vertebra will be opposite to the side of rotation of that vertebra<br></br><br></br>example:<br></br>neutral<br></br>sideband right, rotate left<br></br><b>SPs move right</b><div><br></br></div><div><img></img></div>”
What is type 1 dysfunction?
“follows principle 1 and usually because of contracted <b>long</b> musculature<div><br></br></div><div><img></img></div>”
How do you name somatic dysfunction?
“<div><img></img></div>”
“What is the exception to fryette’s rule?”
”- cervical spine!!<br></br><br></br>- because of the extreme lordosis, convergence of the facets<br></br>- a lot of times will side bend and rotate to the same side (not always)<div><br></br></div><div><img></img></div>”
“What is Fryette’s second law?”
”- spine is in an extreme position: either flexion or extension<br></br>- sidebending induced over one segment <br></br>- rotation occurs in the same direction of the sidebending<br></br>- a normal movement of the spine<br></br><br></br>ex:<br></br>extreme F/E<br></br>two vertebral segments<br></br>notice the top one is sideband right and rotated right<br></br>the rest of the spine is sideband right and rotated opposite (left)<br></br><br></br>T4 FSrRr<div><br></br></div><div><img></img></div>”
What is type II dysfunction?
“follows principle II and usually because of contracted <b>short</b> musculature<div><br></br></div><div><img></img></div>”
What are examples of Type II dysfunctions?
- follows principle 2<br></br>- occur <b>suddenly</b><br></br>- usually the patient is in an <b>extreme</b> position and tries to move in another plane of motion<br></br><br></br>- palpation is important in diagnosis<br></br>- most important is the fact that it follows the type II mechanics <br></br>- can have stacked multiple type II SD
How do we diagnose type I and type II dysfunctions?
“<div><img></img></div>”
“What is Fryette’s third law?”
- instate motion in any plane<br></br>- this will modify the movement in other planes of motion<br></br>- ex: cervical
What are the SPs rule of 3s?
“<div><img></img></div>”
What are the joints of atypical vertebrae?
“<div><img></img></div>”
“What are fryette’s 3 laws?”
“<div><img></img></div>”
What are the 2 types of dysfunction?
“<div><img></img></div>”
How do you do scoliosis testing?
“<div><img></img></div>”
Why is knowledge of physiological motion important?
diagnosis: you need to know about normal motion to evaluate disturbances of motion<br></br><br></br>treatment: it allows you to be specific while treating joint restrictions in all planes and axes
How is somatic dysfunction named?
is always named for its freed of motion <br></br><br></br>ex. named for the directions in which the vertebra or other joint can move most easily<br></br><br></br>(IMP!)
What is the sympathetic chain?
T1 to L2 bilaterally<br></br><br></br>exit with somatic motor axons via IV foramina; travel with somatic axons for much of their course <br></br><br></br>inferior to the head and neck of ribs<br></br><br></br>posterior to pleura
What is the Texas twist?
“<div><img></img></div>”
What is viscerosomatic?
visceral problems affecting the soma
What is somatovisceral?
soma affecting the viscera
What is the somatic nervous system?
“<div><img></img></div>”
What is the parasympathetic nervous system?
“<div><img></img></div>”
What is the sympathetic nervous system?
“<div><img></img></div>”
What are the horizontal diaphragms?
“1. tentorium cerebelli<br></br>2. thoracic inlet/outlet<br></br>3. respiratory diaphragm<br></br>4. pelvic diaphragm<br></br>5. plantar fascia/arches of feet<div><br></br></div><div><img></img></div>”
What are the longitudinal cables?
”- dural sleeve to S2<br></br>- longitudinal ligaments occiput-S2<br></br>- prevertebral, alar, buccopharyngeal fascia<br></br>- psoas major to lower extremity<br></br>- rectus abdominus, q. lumborum, internal/external obliques <br></br>- trachea, esophagus, pericardium on central tendon of diaphragm<br></br>- A/P lower extremity fascia<div><br></br></div><div><img></img></div>”
What are the diaphragms?
“<div><img></img></div>”
What model is assoc. with the respiratory diaphragm?
respiratory-circulatory
What is the other name for the respiratory diaphragm?
thoracoabdominal diaphragm
What are the functions of the respiratory diaphragm?
- respiration: O2, CO2, pH, blood<br></br><br></br>2. lymphatic flow back into circulation
What are the parts, support, transversing structures of the diaphragm?
“<div><img></img></div>”
What are the mechanics of the diaphragm (inhalation/exhalation)?
“INHALATION<br></br>- diaphragm contraction downward<br></br>- decrease pressure, so volume increases<br></br>- air in<br></br><br></br>EXHALATION<br></br>- diaphragm relaxes upward<br></br>- increase pressure<br></br>- so volume decreases<br></br>- air out<div><br></br></div><div><img></img></div>”
Describe doming of the diaphragm
“well domed diaphragm = good contraction, good compliance in inhalation <br></br><br></br>if diaphragm is flattened or spastic, trouble with inhalation<div><br></br></div><div><img></img></div>”
“How does the respiratory diaphragm act as a ““lymphatic pump””?”
”- affected by contraction fo the diaphragm and thoracic cage motion<br></br>- drainage of pleural sacs and lung tissues is to the pre-tracheal nodes and then to the right lymphatic duct<br></br>- assists in fighting infection (tissue immunity)<br></br>- prevents tissue congestion<div><br></br></div><div><img></img></div>”
How does the diaphragm act during respiration?
“<div><img></img></div>”
Where is the thoracic inlet?
“<div><img></img></div>”
What is the inn. to coccygeus?
anterior rami S3-4
What is the innervation to levator ani?
S3 to S4 via inferior rectal n
What forms levator ani?
pubococcygeus<br></br>puborectalis<br></br>iliococcygeus
What forms the pelvic diaphragm?
levator ani and coccygeus muscles
What forms the floor of the pelvic cavity?
pelvic diaphragm
What fascial elements support the pelvis?
“pubovesical ligament<br></br>transverse cervical (cardinal)<br></br>uterosacral<div><br></br></div><div><img></img></div>”
Where is the tentorium cerebelli?
“the process of the Dura mater supporting the occipital lobes and covering the cerebellum.<div><br></br></div><div><img></img></div>”
Where is the plantar fascia?
“bottom of foot<div><br></br></div><div><img></img></div>”
What are the quadrants of the abdomen?
“<div><img></img></div>”
What are the general categories of a visceral differential diagnosis?
“<div><img></img></div>”
What layers are palpated in the abdominal wall?
“<div><img></img></div>”
What must be noted on abdominopelvic palpation?
<b>rigidity, rebound, guarding</b><br></br><br></br>abdominal wall (hernias, masses)<br></br><br></br>layer palpation of organ
How do you use OMT for organ problems?
“<div><img></img></div>”
What are the sympathetic pre-ganglionics?
Greater T5-9<br></br>Lesser T10-11<br></br>Least T12<br></br><br></br>Lumbar L1-2
What does the celiac ganglion innervate?
distal esophagus, liver, stomach, gallbladder, spleen, portions of pancreas, proximal duodenum<br></br><br></br><b>foregut</b>
What does the superior mesenteric ganglion inn.?
portions of pancreas, duodenum, jejunum, ileum, ascending. colon, prox. 2/3 transverse colon, adrenals, gonads, kidneys, upper ureter<br></br><br></br><b>midgut</b>
What does the inferior mesenteric ganglion inn.?
distal 1/3 transverse colon, descending colon, sigmoid, rectum, lower ureter, bladder, genitalia <br></br><br></br><b>hindgut</b>
What things must you note on initial examination?
- gross deformity<br></br>- muscle asymmetry <br></br>- skin changes (rash, erythema, ecchymosis)<br></br>- edema
In a posterior examination, what landmarks should you note for symmetry?
- iliac crests<br></br>- waist crease<br></br>- greater trochanter<br></br>- pelvic position (no shift)<br></br>- hip position (not in flexion/extension)<br></br>- foot position
What should you note on gait to ensure symmetry?
check for:<br></br>- limp<br></br>- stiffness<br></br>- antalgic gait
What bony landmarks can be palpated posteriorly?
“iliac crests<br></br>PSIS<br></br>greater trochanter <br></br>gluteal lines<div><br></br></div><div><img></img></div>”
What muscles of the lower extremity can be palpated?
“<div><img></img></div>”
What are the ROM exercises of the hip?
“note when you turn the leg laterally you are testing the <b>medial</b> hip joint<div><br></br></div><div><img></img></div>”
What is the normal ROM of the hip?
“<div><img></img></div>”
What is the FABERE Test?
“flexion<br></br>abduction<br></br>ext. rotation<br></br>extend<br></br><br></br>make a 4<div><br></br></div><div><img></img></div>”
What is a positive FABERE test?
pain at the SI joint or hip joint
What is the Trendelenburg sign?
“drooping of contralateral hemipelvis below its normal horizontal level during monopedal stance<br></br>caused by weakness or paralysis of the gluteus medius and minimus muscles<br></br><br></br>innervated by the superior gluteal muscle<div><br></br></div><div><img></img></div>”
What are travell trigger points?
“just know that referred pain can occur<br></br><br></br>even though pain is in one place, pain can occur elsewhere<div><br></br></div><div><img></img></div>”
What muscle energy manipulations can be done for the psoas/hip pain?
“note this is isometric - the muscle shouldn’t move<div><br></br></div><div><img></img></div>”
What are the psoas stretching exercises?
“left is modified for person who can’t kneel<br></br><br></br>Left picture is stretching L. psoas<br></br>Right pictures is stretching R. psoas <br></br><br></br>important to stay upright! lean forward with contralateral leg and extend ipsilateral (pain) leg<div><br></br></div><div><img></img></div>”
What are the guidelines for giving exercise instruction?
“<div><img></img></div>”
What are the gluteal strengthening exercises?
“note from TL to bottom are different levels of difficulty depending on pts. strength<div><br></br></div><div><img></img></div>”
What are the innominates?
“ilium, ischium, pubis.<div><br></br></div><div><img></img></div>”
What are the 3 true pelvic ligaments?
”- anterior sacroiliac<br></br>- interosseus<br></br>- posterior sacroiliac<div><br></br></div><div><img></img></div>”
What are the accessory pelvic ligaments?
”- sacrotuberous<br></br>- iliolumbar<br></br>- sacrospinous<div><br></br></div><div><img></img></div>”
What is the function the true pelvic ligaments?
restrain posterior, lateral, and axial rotation
What is the function of the accessory pelvic ligaments?
- restrain anterior movement and rotation<br></br>- also has role in vertical stability
What are the muscles of the back with pelvic attachments?
“abdominal obliques <br></br>- internal - iliac crest<br></br>- external - iliac crest and pubic tubercle<br></br><br></br>erector spinae<br></br>- iliac crest<br></br>- ligaments<div><br></br></div><div><img></img></div>”
What are the muscles of the anterior thigh with pelvic attachments?
”- adductors (attach to pubic bones)<br></br><br></br>- rectus femoris (origin is AIIS)<div><br></br></div><div><img></img></div>”
What are the muscles of the lateral thigh with pelvic attachments?
“Tensor fascia lata<br></br>attaches to ASIS and iliac crest<div><br></br></div><div><img></img></div>”
What are the muscles of the anterior back with pelvic attachments?
“quadratus lumborum<br></br>- O: iliac crest<br></br>- I: 12th rib<br></br><br></br>psoas<br></br>O: L1-4<br></br>I: lesser trochanter femur<div><br></br></div><div><img></img></div>”
What are the landmarks on the innominates?
”- PSIS<br></br>- ASIS<br></br>- pubic tubercle<br></br>- ischial tuberosity<br></br>- iliac crest<div><br></br></div><div><img></img></div>”
What are the steps of the physical exam?
- gait<br></br>- structural asymmetry<br></br>- curvature of the spine<br></br>- postural balance<br></br>- motion testing
What tests are done with patient supine?
- hip flop<br></br>- medial malleoli levelness<br></br>- pubic bones<br></br>- ASIS levelness<br></br>- ASIS compression test
What is the hip flop test?
”- pt supine<br></br>- hips and knees bent<br></br>- pt lifts butt up and sets it down<br></br>- physician straightens legs<br></br>- pt. <b>passive</b> and relaxed<br></br>- check medial malleoli levelness<div><br></br></div><div><img></img></div>”
What is pubic symphysis evaluation?
”- hand palm caudad; fingers pointing cephalad<br></br>- walk hand down until contact with the bone<br></br>- place fingers cephalad on the pubic tubercles <br></br>- compare L to R side<br></br><br></br>this test would then need to be followed up with flexion test or ASIS test<div><br></br></div><div><img></img></div>”
What is an ASIS evaluation?
“compare L and R ASIS for symmetry<div><br></br></div><div><img></img></div>”
What does the ASIS compression test examine?
“assess for restriction at the SI joint<div><br></br></div><div><img></img></div>”
How would you perform an ASIS compression test?
”- pt. lying on asymptomatic side<br></br>- put iliac up on the side effected <br></br>- put hand on anterior rim of ilium and apply 3-6x thrusts downward pressure <br></br>- look to reproduce symptoms posteriorly<div><br></br></div><div><img></img></div>”
What tests are done with the patient prone?
- iliac crests<br></br>- PSIS<br></br>- iliolumbar ligaments <br></br>- ischial tuberosities<br></br>- sacrotuberous ligaments
What posterior landmarks can be examined without a hip flop?
”- iliac crest<br></br>- PSIS<div><br></br></div><div><img></img></div>”
Where is the ischial tuberosity?
- gluteal folds<br></br>- SITS bones<br></br>- sacrotuberous ligament attached
What is the standing flexion test?
”- standing position feet shoulder length apart<br></br>- operator behind patient, eye level, with thumbs <b>UNDER</b> the PSIS<br></br>- patient bends forward<br></br>- <b>motion restriction = PSIS moves cephalad</b><div><br></br></div><div><img></img></div>”
What does the standing flexion test evaluate?
gross evaluation of iliosacral motion
How would a positive standing flexion test evaluate?
motion restriction = PSIS moves cephalad<br></br><br></br><b>iliosacral dysfunction</b><br></br><br></br>contralateral tight hamstrings; sacroiliac dysfunction
What is the seated flexion test?
”- patient is seated<br></br>- operator behind patient, eyes level and thumbs <b>UNDER</b> the PSIS<br></br>- same as standing flexion test <br></br>- removes innominates as factor<div><br></br></div><div><img></img></div>”
What does a seated flexion test evaluate?
sacroiliac dysfunction
What are the 3 pelvic motions?
- pubic motions<br></br>- iliac motions on the sacrum<br></br>- sacral motions on the ilium
What are the pubic motions?
”- caliper<br></br>- torsional <br></br>- superoinferior translatory<div><br></br></div><div><img></img></div>”
What are the pubic dysfunctions?
- superior pubes<br></br>- inferior pubes<br></br>- abducted pubes<br></br>- adducted pubes
What is a superior pubic shear?
”- one pubic bone is displaced compared to the other <br></br>- etiology - tight rectus abdominus or trauma<br></br><br></br>correct by having pt hang affected side off table, place hand on contralateral ASIS, have pt. attempt to lift knee to contralateral elbow while you apply force<div><br></br></div><div><img></img></div>”
What is an inferior pubic shear?
”- ASIS level or inferior <br></br>- PSIS level or superior <br></br>- etiology - tight adductors or trauma<br></br><br></br>treat:<br></br>flex knee up and put it into shoulder crease, flex up to barrier, patient applies opposite force<div><br></br></div><div><img></img></div>”
What is pubic adduction?
”- suspicion of dysfunction by history<br></br>- bulging of pubic symphysis<br></br>- tenderness<br></br>- urinary symptoms<div><br></br></div><div><img></img></div>”
What is abduction?
”- suspicion of dysfunction by history<br></br>- sulcus deeper than normal<br></br>- tenderness<br></br>- urinary tract symptoms<div><br></br></div><div><img></img></div>”
What are the types of ilial motion?
“<div><img></img></div>”
What is anterior innominate rotation?
”- ASIS more inferior<br></br>- PSIS more superior <br></br>- ipsilateral hamstring tightness/spasm and sciatic are common complaints<br></br>- tissue changes at ILA os sacrum same side, as well as iliolumbar ligament tenderness<br></br>- freedom of motion <b>anteriorly</b> <br></br><br></br>etiology:<br></br>- hypertonic quads<br></br>- hypertonic QL<br></br>- hypertonic adductors<div><br></br></div><div><img></img></div>”
How would you correct anterior innominate rotation?
“rotate the ilium posteriorly<div><br></br></div><div><img></img></div>”
What is posterior innominate rotation?
”- ASIS more superior <br></br>- PSIS more inferior<br></br>- inguinal/groin pain and/or medial knee pain<br></br>- inguinal tenderness and tissue changes at sacral sulcus<br></br>- freedom of motion <b>posteriorly</b><br></br><br></br>Etiology:<br></br>hypertonic hamstrings<br></br>hypertonic rectus abdominus<div><br></br></div><div><img></img></div>”
How would you correct posterior innominate rotation?
“rotate ilium anteriorly<div><br></br></div><div><img></img></div>”
What is a superior innominate shear?
”- ASIS more superior<br></br>- PSIS more superior <br></br>- pubic ramus more superior <br></br>- pelvic pain<br></br>- tissue changes at the ipsilateral SI joint and pubes<br></br>- motion freedom superior translation<br></br><br></br>etiology<br></br>- fall to the buttocks/knee - same side<br></br>- sitting/standing unevenly<div><br></br></div><div><img></img></div>”
What is an inferior innominate shear?
”- ASIS more inferior<br></br>- PSIS more inferior<br></br>- pubic ramus inferior<br></br>- same complaint of pelvic pain<br></br>- same tissue changes<br></br>- <b>RARE</b><div><br></br></div><div><img></img></div>”
What are innominate flares?
“ASIS medial or lateral to its usual position<div><br></br></div><div><img></img></div>”
What is an innominate inflare v. outflare?
inflare - adducted; <b>anterior rotation</b><br></br>out flare - abducted; <b>posterior rotation</b>
How would you evaluate an innominate flare?
”- transverse line connecting the ASIS’<br></br>- then connecting each ASIS to the umbilicus<br></br>- visually connect the line from the umbilicus to the pubic bone<br></br>- examine the two triangles and find the flare<div><br></br></div><div><img></img></div>”
How would you do HVLA for a superior shear?
”- pt. supine<br></br>- physician at foot of table<br></br>- grasp the patients lower leg above malleoli w/ both hands and apply traction<br></br>- keep hip in neutral <br></br>- internal rotate leg to take up tension<br></br>- slightly abduct<br></br>- instruct pt. to inhale and exhale, taking up slack with exhale<br></br>- final corrective force is a short quick pull on the leg<div><br></br></div><div><img></img></div>”
What are the innominates?
ilium, ischium, pubis. (acetab is all three)
What is the osteology of the sacrum?
”- lumbosacral facets<br></br>- five segments<br></br>- four coccygeal segments<div><br></br></div><div><img></img></div>”
What is it called when the lumbosacral junction contains transitional vertebrae?
- lumbarization<br></br>- sacralization
What is sacralization of L5?
“L5 fused with sacrum; hypermobility of L4 and up<div><br></br></div><div><img></img></div>”
What is lumbarization of S1?
“Total or partial separation of S1 from sacrum<div><br></br></div><div><img></img></div>”
“What is Ferguson’s angle?”
“lumbosacral angle, 25-35 degrees<div><br></br></div><div><img></img></div>”
Are there any direct muscular attachments to the sacrum?
NOPE
What are the true pelvic ligaments?
”- anterior sacroiliac<br></br>- interosseus<br></br>- posterior sacroiliac<br></br><br></br>restrain posterior, lateral, and axial rotation<div><br></br></div><div><img></img></div>”
What are the accessory pelvic ligaments?
”- sacrotuberous<br></br>- iliolumbar<br></br>- sacrospinous<br></br><br></br>restrain anterior movement and rotation, also has a role in vertical stability<div><br></br></div><div><img></img></div>”
What nerves are assoc. with the sacrum?
sacral plexus<br></br>sacral parasympathetics<br></br>ganglion impar
What nerves are included in the sacral plexus?
contain both motor and sensory in the pelvis and lower extremity
What nerves are assoc. with sacral parasympathetics?
S2-4
What is the ganglion impar?
is where the right and left sympathetic chains join and rests on the anterior surface of the coccyx
What are the landmarks of the sacrum?
“<div><img></img></div>”
What are the transverse axes of rotation?
”- superior (S2 segment, assoc with respiratory and craniosacral motion)<br></br><br></br>- middle (located at anterior convexity, S2 sacral body, assoc. with postural flexion and extension)<br></br><br></br>- inferior (posterior inferior part of the inferior limb of the SI joint, assoc. with ilial rotation)<div><br></br></div><div><img></img></div>”
What are the oblique axes of rotation?
”- right<br></br>- left<br></br><br></br>assoc. with combination of 2 motions: side bending and rotation<div><br></br></div><div><img></img></div>”
What is the superior transverse axis?
“S2 segment <br></br>posterior to SI joint<br></br>respiration<br></br>craniosacral motion<div><br></br></div><div><img></img></div>”
What is the middle transverse axis?
“located at anterior convexity<br></br>S2 sacral body<br></br>postural flexion and extension <br></br>AKA: sacroiliac axis<div><br></br></div><div><img></img></div>”
What is the inferior transverse axis?
“posterior inferior part of the inferior limb of the SI joint<br></br>ilial (innominate) rotation<div><br></br></div><div><img></img></div>”
What are the types of sacral motion?
Postural <br></br>- flexion extension<br></br>- rotation<br></br>- sidebending<br></br>- torsion<br></br><br></br>inherent<br></br><br></br>respiratory<br></br><br></br>dynamic
How does the sacrum move in sacral flexion?
- base of the sacrum moves anterior for anatomic flexion<br></br>- motion is about the middle transverse axis
How does the sacrum move in sacral extension?
- anatomical extension - the base of the sacrum moves posteriorly <br></br>- movement is about the middle transverse axis
What axis does the sacrum rotate around?
occurs around a vertical axis
What axis does sacral side-bending occur around?
occurs around A-P axis
What does the standing flexion test evaluate?
”- gross evaluation of iliosacral motion<br></br>- standing position feet shoulder length apart<br></br>- operator behind patient with thumbs <b>under</b> the PSIS<br></br>- patient bends forward<br></br>- <b>motion restriction = PSIS moves cephalad</b><div><br></br></div><div><img></img></div>”
What is the seated flexion test?
”- evaluates <b>sacroiliac</b> dysfunction<br></br>- patient is seated<br></br>- operator behind patient, eyes level, and thumbs <b>under</b> the PSIS<br></br>- same as standing flexion test<br></br>- <b>removes innominates as a factor</b><div><br></br></div><div><img></img></div>”
What is the spring test?
”- tests for <b>forward torsions</b><br></br>- patient prone<br></br>- heel of hands on the LS junction<br></br>- gentle but rapid force applied downward<br></br>- good spring = negative test<br></br>- poor spring = positive test<div><br></br></div><div><img></img></div>”
What is a negative spring test?
negative = good spring<br></br><br></br>nice, normal, negative
What is a positive spring test?
positive = poor spring<br></br><br></br>posterior, painful, positive
What is the sphinx test?
“palpate for sacral sulci<br></br>- deep<br></br>- shallow<br></br><br></br>ILA<br></br>- anterior<br></br>- posterior<div><br></br></div><div><img></img></div>”
How do you describe sacral torsion?
described relative to L5
What position is the sacrum in a forward sacral torsion?
flexed
What is a Left on Left torsion?
”- deep sulcus: right<br></br>- inferior/posterior ILA: L<br></br>- seated flexion: +R<br></br>- spring test: negative<div><br></br></div><div><img></img></div>”
What is a Right on Right torsion?
”- deep sulcus: left<br></br>- inferior/posterior ILA: R<br></br>- seated flexion: +L<br></br>- spring test: negative<div><br></br></div><div><img></img></div>”
What direction is the sacrum in a backward sacral torsion?
extended
What is a left on right sacral torsion?
”- deep sulcus: right<br></br>- inferior/posterior ILA: L<br></br>- seated flexion: + Left<br></br>- spring test +<div><br></br></div><div><img></img></div>”
In L/L and R/R sacral torsions, what general direction is the sacrum?
forward/flexed
What is right on left sacral torsion?
“deep sulcus: left<br></br>inferior/posterior ILA: R<br></br>seated flexion: + R<br></br>spring test +<div><br></br></div><div><img></img></div>”
What is the other name for unilateral sacral flexion?
left sacral shear
What is a left unilateral sacral flexion?
“deep sulcus: L<br></br>inferior/posterior ILA: L<br></br>seated flexion test +L<br></br><b>negative spring test</b><br></br><br></br>(right is opposite)<div><br></br></div><div><img></img></div>”
What is unilateral sacral extension (on L)?
“deep sulcus: R<br></br>inferior/posterior ILA: R<br></br>seated flexion test: +L<br></br><br></br>(right is opposite)<br></br><br></br><b>SPRING TEST +</b><div><br></br></div><div><img></img></div>”
What is the position of the sacrum in bilateral sacral dysfunction?
ILAs and sacral sulci are even
What is a bilateral flexed sacrum?
- motion decreased bilaterally<br></br>- sacrum flexes but is restricted in extension<br></br>- spring test negative<br></br>- seated flexion test is positive bilaterally
What is a bilateral extended sacrum?
- motion decreased bilaterally<br></br>- sacrum extends but is restricted in flexion<br></br>- spring test is positive
What are the conventional models of medicine?
“Conventional Model<br></br>-Biology<br></br>-Chemistry<br></br>-(Physics/Math)<br></br>-Anatomy<br></br>-Physiology<br></br>-Pharmacology<br></br>-Surgery<br></br>-Psychiatry<div><br></br></div><div><img></img></div>”
What is the expanded integrative model of medicine?
“All of the Conventional +<br></br>Biophysics<br></br>Consciousness<br></br>Spirituality<div><br></br></div><div><img></img></div>”
What model is used in osteopathic medicine?
“whole person model<div><br></br></div><div><img></img></div>”
What is integrative medicine?
“l”“Integrative Medicine”” is defined as a healing-oriented medicine that take account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship (between the patient and physician) and makes use of all appropriate therapies, both conventional and alternative. (Rakel, Integrative Medicine, 4th edition, 2017).<div><br></br></div><div><img></img></div>”
Draw the osteopathic philosophy, principles, and practice chart
“<div><img></img></div>”
What models are based on biochemical/physical conventional medicine?
“interventional, symptomatic, emergency<div><br></br></div><div><img></img></div>”
What are the alternative paradigms seen in complementary/alternative medicine (CAM)?
“holistic, interdimensional, root cause<div><br></br></div><div><img></img></div>”
What is the clinical horizon?
“where disease will appear<div><br></br></div><div><img></img></div>”
Chart how clinical horizon will be altered with alternative medicine
“stay closer to healthy state<div><br></br></div><div><img></img></div>”
LIst conventional and alternative methods of medicines
“<div><img></img></div>”
List methods of conventional and alternative physical therapy
“<div><img></img></div>”
List methods of conventional and alternative psycotherapies
“<div><img></img></div>”
What are the different type of botanicals used in medicine?
“1.Herbalism<br></br>A.Western<br></br>B.Chinese<br></br>C.Ayurvedic<br></br><br></br>2.Essential Oils<div><br></br></div><div><img></img></div>”
What are the alternative systems of medicine?
“1.”“Osteopathy”“<br></br>2.Chiropractic<br></br>3.Naturopathy<br></br>4.Homeopathy<br></br>5.Oriental Medicine<br></br>6.Ayurveda<div><br></br></div><div><img></img></div>”
List the different types of energy medicine
“1.OMT (Dynamic Strain-Vector Release, Neurofascial Release, others)<br></br>2.Acupuncture<br></br>3.Qi Gong<br></br>4.Reiki<br></br>5.Therapeutic Touch/Healing Touch<br></br>6.Pranic Healing<br></br>7.Marma Therapy<br></br>8.Jin Shin<br></br>9.Chakra Therapies<br></br>10.Magnetic Therapies<br></br>11. Polarity Therapy<br></br>12. Zero Balancing<br></br>13. PEMF, TENSCAM and other devices<br></br>Acoustic (Sound) Therapies<br></br>-Music Therapy<br></br>-Tomatis Method<br></br>-Other<br></br>14. Color Therapies<br></br>-Art Therapy<br></br>-Colorpuncture<br></br>-Laser therapy<div><br></br></div><div><img></img></div>”
What are medicines that use manipulation and therapeutic bodywork
“1.”“OMT”“<br></br>2.Craniosacral Therapy™<br></br>3.Chiropractic manipulation<br></br>4.Therapeutic Massage<br></br>5.Trigger Point Myotherapy<br></br>6.Rolfing<br></br>7.Reflexology”
What are the different movement therapies?
“1.”“OMT”“<br></br>2.Craniosacral Therapy™<br></br>3.Chiropractic manipulation<br></br>4.Therapeutic Massage<br></br>5.Trigger Point Myotherapy<br></br>6.Rolfing<br></br>7.Reflexology”
What are the different mind-body therapies?
“1.Biofeedback<br></br>-EEG (““Central””)<br></br>-““Peripheral”“<br></br>2.Hypnosis<br></br>3.Guided Imagery<br></br>4.Energy Psychology<br></br>5.Shamanism<br></br>6.Meditation<br></br>7.Prayer<div><br></br></div><div><img></img></div>”
What are the different pharmacologc/biologic therapies?
“1.Chelation Therapy<br></br>2.Prolotherapy<br></br>3.Platelet Rich Plasma (PRP)<br></br>4.Stem Cell Therapies<div><br></br></div><div><img></img></div>”
What are the different types of nutrition therapy?
“1.Diets<br></br>2.Orthomolecular Medicine (Supplements)<div><br></br></div><div><img></img></div>”
Compare osteopathy vs. chiropractic
“Osteopathy first class 1892 (Kirksville, MO)<br></br>Chiropractic first class 1896 (Davenport, IA)<br></br>A.T. Still, MD and D.D. Palmer knew each other (studied ““magnetic healing”” with Paul Caster, Ottumwa, IA)<br></br>Palmer visited Still at A.S.O. prior to starting chiropractic<div><br></br></div><div><img></img></div>”
Read the following article
“http://jaoa.org/article.aspx?articleid=2094619<div><br></br></div><div><img></img></div>”
What are the 3 main types of chiropractors?
“1.”“Straight”” - focus on spinal subluxations<br></br>2.”“Mixers”” - utilize other treatments like nutrition, other types of physiotherapy<br></br>3.Network Spinal Analysis (NSA) or ““Network Chiropractic””- Donald Epstein, DC<div><br></br></div><div><img></img></div>”
What is emphasized by naturopathy?
“Emphasizes ““Natural Healing”“<br></br>Nutrition, prevention, herbalism, manipulation, homeopathy, acupuncture, colon hydrotherapy”
How many naturopathic schools are found in the US?
7 accredited schools
Who founded naturopathy?
“Benedict Lust<div><br></br></div><div><img></img></div>”
What are the 3 principles of naturopathic philosophy?
“1.Body is self-healing, Tx directed toward support of self-healing mechanism (vis medicatrix naturae, i.e. vital force)<br></br>2. Symptoms a sign that body is striving to eliminate toxins, return to homeostasis<br></br>3. Holistic approach, body, mind, spirit, social<div><br></br></div><div><img></img></div>”
What is homeopathy?
“treating like with like<div><br></br></div><div><img></img></div>”
What did samuel hahnemann do?
“founder<br></br>Experimented with low doses of quinine (antimalarial), noting his reactions to it.<br></br>Found that each time he took a minute dose, would get symptoms of malaria; stopping dose, Sx resolved.<div><br></br></div><div><img></img></div>”
What is the theory of homeopathy?
“Theorized that a substance that causes symptoms in a well person can be used to cure similar symptoms when they result from an illness.<br></br><br></br>Tested hundreds of substances on himself (samuel hanhnemann) and others, developing symptoms of illness = ““provings”””
what is the law of similars in homeopathy?
“Prescribing minute doses of a substance (remedy) that causes similar symptoms of the illness.<div><br></br></div><div><img></img></div>”
What is the law of cure of homeopathy?
Law of Cure = Remedies work from<br></br>1. Top to bottom<br></br>2. Inside to outside<br></br>3. From major organs to minor organs<br></br>4. Symptoms clear in reverse order of appearance
What is included in oriental medicine?
“A system of healthcare:<br></br>• At least 3,000 years old<br></br>• Developed in the East (China)<br></br>• Includes:<br></br>- Herbalism<br></br>- Nutrition<br></br>- Acupuncture<br></br>- Massage (Tui na)<br></br>- Exercise<div><br></br></div><div><img></img></div>”
What are the different models of oriental medicine?
“<div><img></img></div>”
What is ayureveda?
”"”Science of Life”“<br></br>A system of healthcare:<br></br>At least 5,000 years old (?oldest)<br></br>Developed in India<br></br>Science<br></br>Philosophy<br></br>Spirituality<div><br></br></div><div><img></img></div>”
What are the 5 basic elements and 3 basic principles of ayurveda?
“<div><img></img></div>”
What are the possible prescriptions of ayurveda?
“<div><img></img></div>”
What is Wu Wei?
“no action out of harmony with nature<div><br></br></div><div><img></img></div>”
