OPP Exam 2 Flashcards
1
Q
Where do ribs articulate? (general)
A
Anteriorly with sternum, posteriorly with vertebral column
2
Q
What are the functions of the thoracic cage?
A
nRespiration<br></br>nProtection of vital organs<br></br>nPump for venous and lymphatic return<br></br>nSupport structure for the upper extremities
3
Q
“What is the rule of 3’s of the spinous processes?”
A
“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.”
4
Q
Which part of the vertebral column will have limited motion?
A
Upper thoracic vertebrae: limited in motion due to anterior attachment of the ribs (unlike floating ribs which allow more motion)
5
Q
What are the true ribs, and where do they attach?
A
True ribs: 1-7<br></br>Attach directly to the sternum via costochondral cartilage<br></br><br></br>have catilaginous attachment to sternum!!
6
Q
What are the false ribs and where do they attach?
A
False ribs: 8-12<br></br><br></br>Ribs 8-10 attach via a synchondroses to the costochondral cartilage of rib 7
7
Q
What are the floating ribs?
A
Floating (subclass false): 11-12<br></br><br></br>Do not attach to the sternum at all
8
Q
What are the typical and atypical ribs?
A
nTypical: ribs 3-9 (10)<br></br><br></br>nAtypical: ribs 1, 2, (10), 11, 12
9
Q
What is unique about rib 1?
A
”- articulates T1 - head of rib on body<br></br>- no angle<div><br></br></div><div><img></img></div>”
10
Q
What is unique about rib 2?
A
“large tuberosity on shaft for serratus anterior<div><br></br></div><div><img></img></div>”
11
Q
What is unique about ribs 11 and 12?
A
“articulates with vertebrae only<br></br>no tubercles<div><br></br></div><div><img></img></div>”
12
Q
What anatomical landmarks are found on typical ribs (3-10)?
A
”- tubercle<br></br>- head<br></br>- neck<br></br>- angle<br></br>- shaft<div><br></br></div><div><img></img></div>”
13
Q
What is contained within the costal groove?
A
intercostal vein, artery, and nerve <br></br><br></br>insert needle on superior aspect to avoid these structures
14
Q
Where will T1, T11, and T12 articulate with ribs?
A
head of ribs only articulate with body
15
Q
What are the costochondral articullations seen in the ribs?
A
Rib 1<br></br>Synchondrosis (non-synovial)<br></br><br></br>Ribs 2-7<br></br>Synovial articulations
16
Q
What is costochondritis?
A
inflammation of cartilage that connects ribs
17
Q
What nerve is at risk with an increased first rib?
A
lower brachial plexus: ulnar nerve <br></br><br></br>will affect 4th and 5th digits
18
Q
List a clinical way that the brachial plexus may become impinged
A
patient with respiratory problems that uses anterior/middle scalene as accessory respiratory muscle: muscles can hypertrophy and compress brachial plexus
19
Q
“What is Sibson’s fascia?”
A
a thickened area of endothoracic fascia at the apex of the lung<br></br><br></br>lymph vessel travels through this fascia!!!
20
Q
“What can result from tension in sibson’s fascia?”
A
can compress lymphatic vessels that pierce the layer: alters flow of fluid in the body
21
Q
What are the borders of the thoracic inlet?
A
first rib, vertebral body, sternum
22
Q
What motions are seen in rib 1?
A
50/50 bucket and pump handle motion: anterior scalenes (anterior) pump handle, middle scalenes (lateral) bucket handle
23
Q
What is the motion at ribs 1-7 costotransverse joints?
A
rotates
24
Q
What is the motion at ribs 8-10 costotransverse joints?
A
glides
25
What is the motion at ribs 11, 12 costotransverse joints?
do not articulate with transverse process
26
What ribs display pump-handle motion?
ribs 2-5
27
What ribs display bucket-handle motion?
ribs 6-10
28
What ribs display caliper motion?
11 and 12
29
What ribs will show all 3 motions?
4-6
30
Where are pump-handle ribs best palpated for motion?
mid-clavicular line
31
Describe pump-handle motion
"- move anterior and superior with inhalation
- motion predominantly in sagittal plane
- best palpated at mid-clavicular line
- axis of motion is costovertebral-costotransverse line
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- motion predominantly in sagittal plane
- best palpated at mid-clavicular line
- axis of motion is costovertebral-costotransverse line
32
Describe pump handle motion in inhalation and exhalation
"increases AP diameter
inhalation - anterior rib moves cephalad (superiorly), posterior rib moves caudad (inferiorly)
exhalation - opposite of inhalation
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inhalation - anterior rib moves cephalad (superiorly), posterior rib moves caudad (inferiorly)
exhalation - opposite of inhalation
33
Where are bucket handle motion ribs best palpated?
mid-axillary line
34
Describe bucket handle motion
"(ribs 6-10)
- ribs move laterally and increase transverse diameter with inhalation
- motion predominantly in coronal plane
- best palpated at mid-axillary line
- axis of motion is costovertebral-costosternal line
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- ribs move laterally and increase transverse diameter with inhalation
- motion predominantly in coronal plane
- best palpated at mid-axillary line
- axis of motion is costovertebral-costosternal line
35
What diameter is increased with bucket handle motion?
"transverse diameter of rib cage
rib shaft is the handle of the bucket
rib shaft lifts during inhalation, falls with exhalation
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"
rib shaft is the handle of the bucket
rib shaft lifts during inhalation, falls with exhalation
36
Where are caliper motion ribs best palpated?
3-5 cm lateral to TP
37
Describe caliper motion
"(ribs 11-12)
ribs externally rotate with inhalation
motion predominantly in transverse plane
best palpated 3-5 cm lateral to transverse processes
axis of motion is vertical line
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"
ribs externally rotate with inhalation
motion predominantly in transverse plane
best palpated 3-5 cm lateral to transverse processes
axis of motion is vertical line
38
What are the principal muscles for rib elevation
"diaphragm
external intercostals
interchondral internal intercostals
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"
external intercostals
interchondral internal intercostals
39
What are the anterior accessory muscles for rib elevation?
"SCM
anterior-middle scalene
posterior scalene
serratus anterior (inferior fibers)
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"
anterior-middle scalene
posterior scalene
serratus anterior (inferior fibers)
40
What are the posterior accessory muscles for rib elevation?
serratus posterior superior
levatores costarum
levatores costarum
41
What muscle is accessory for rib elevation during forced inspiration?
"pec minor
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"
42
What muscles are responsible for rib depression during quiet breathing?
"1. passive recoil from lungs
2. diaphragm relaxation
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2. diaphragm relaxation
43
What muscles are involved in rib depression during active breathing?
"1. internal, innermost intercostals
2. abdominal muscles (rectus abdominus, ext/int obliques, transversus abdominus)
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2. abdominal muscles (rectus abdominus, ext/int obliques, transversus abdominus)
44
What are the accessory muscles of rib depression
1. serratus posterior inferior (stabilizes ribs against upward pull of diaphragm)
2. ext/internal obliques, transversus abdominus
3. transversus thoracis
2. ext/internal obliques, transversus abdominus
3. transversus thoracis
45
How is rib somatic dysfunction named?
based on dynamic findings
46
Where is the key rib normally found in inhalation somatic dysfunction?
"lower
BITE: bottom inhalation, top exhalation
elevates with inspiration (ease)
""stuck in"" inhalation
exhalation restriction - won't move inferior with expiration
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"
BITE: bottom inhalation, top exhalation
elevates with inspiration (ease)
""stuck in"" inhalation
exhalation restriction - won't move inferior with expiration
47
Where is the key rib normally found in exhalation somatic dysfunction?
"upper
BITE
moves inferiorly with expiration (ease)
""stuck in"" exhalation
inhalation restriction
won't move superior with inspiration
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"
BITE
moves inferiorly with expiration (ease)
""stuck in"" exhalation
inhalation restriction
won't move superior with inspiration
48
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.
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"
49
Who verified existence of viscerosomatic reflexes?
I.M. Korr Ph.D
50
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.
51
What are the clinical uses of viscerosomatic reflexes?
"correlate with patient's history and PE
can use to monitor progress"
can use to monitor progress"
52
What is rib raising?
influences ribcage mechanics to enhance venous and lymphatic flow and respiratory exchange
53
How do you perform rib raising?
"- patient supine
- physician at side of table
- hands under patient with finger pads ""hooking"" the rib angles
- exert a ventral and lateral force perpendicular to the paraspinal muscles
- use the forearm as a fulcrum - downward pressure of the forearm = ventral force through the hands
- may hold and wait for a release or ...
- move up and down the thoracic spine in a gentle, rhythmic, kneading fashion
- reassess tissue tension
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"
- physician at side of table
- hands under patient with finger pads ""hooking"" the rib angles
- exert a ventral and lateral force perpendicular to the paraspinal muscles
- use the forearm as a fulcrum - downward pressure of the forearm = ventral force through the hands
- may hold and wait for a release or ...
- move up and down the thoracic spine in a gentle, rhythmic, kneading fashion
- reassess tissue tension
54
What are the 3 planes of motion?
"coronal, sagittal, horizontal
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"
55
What are the 3 axis?
AP (anterior-posterior)
Transverse
Vertical
Transverse
Vertical
56
What movement occurs in the coronal plane?
"- transects AP
- side bending! (around an AP axis)
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- side bending! (around an AP axis)
57
What movement occurs in the sagittal plane?
"- transects left and right
- flexion and extension (around a transverse axis)
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- flexion and extension (around a transverse axis)
58
What movement occurs in the transverse plane?
"- transects superior/inferior
- rotation occurs (around vertical axis)
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- rotation occurs (around vertical axis)
59
What is the function of the anterior segment of vertebrae?
"- support
- weight bearing
- shock absorbing
- protection of the spinal cord
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- weight bearing
- shock absorbing
- protection of the spinal cord
60
What is the tripod arrangement of the vertebrae?
"- anterior: column contains the vertebral bodies and the IV discs
- posterior: column contains the rest; the TPs and SPs
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- posterior: column contains the rest; the TPs and SPs
61
What is the function of the posterior segment of vertebrae?
"- directs joint motion
- protects spinal cord
- almost non-weight bearing the upright position
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- protects spinal cord
- almost non-weight bearing the upright position
62
What are the properties of the anterior column?
"![]()
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63
What are the properties of the posterior column?
"![]()
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64
What are some structures that limit motion of the spinal column?
- ligaments
- muscular attachments
- osteology (shape of vertebrae and facets)
- IV discs
- disease causing structural changes
- muscular attachments
- osteology (shape of vertebrae and facets)
- IV discs
- disease causing structural changes
65
What is flexion and extension?
"- flexion is anterior approximation
- extension is anterior separation
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- extension is anterior separation
66
What is rotation right and left?
"- turning the anterior aspect of the body to the right
- turning the anterior aspect of the body to the left respectively
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- turning the anterior aspect of the body to the left respectively
67
What is side bending?
"upper vertebral body approximates the one below it
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"
68
Who is Fryette?
"- 1918
- Harrison Fryette presented a paper
- described vertebral motions
- developed principles to follow
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- Harrison Fryette presented a paper
- described vertebral motions
- developed principles to follow
69
"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
example:
neutral
sideband right, rotate left
SPs move right
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example:
neutral
sideband right, rotate left
SPs move right
70
What is type 1 dysfunction?
"follows principle 1 and usually because of contracted long musculature
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71
How do you name somatic dysfunction?
"![]()
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72
"What is the exception to fryette's rule?"
"- cervical spine!!
- because of the extreme lordosis, convergence of the facets
- a lot of times will side bend and rotate to the same side (not always)
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- because of the extreme lordosis, convergence of the facets
- a lot of times will side bend and rotate to the same side (not always)
73
"What is Fryette's second law?"
"- spine is in an extreme position: either flexion or extension
- sidebending induced over one segment
- rotation occurs in the same direction of the sidebending
- a normal movement of the spine
ex:
extreme F/E
two vertebral segments
notice the top one is sideband right and rotated right
the rest of the spine is sideband right and rotated opposite (left)
T4 FSrRr
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"
- sidebending induced over one segment
- rotation occurs in the same direction of the sidebending
- a normal movement of the spine
ex:
extreme F/E
two vertebral segments
notice the top one is sideband right and rotated right
the rest of the spine is sideband right and rotated opposite (left)
T4 FSrRr
74
What is type II dysfunction?
"follows principle II and usually because of contracted short musculature
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"
75
What are examples of Type II dysfunctions?
- follows principle 2
- occur suddenly
- usually the patient is in an extreme position and tries to move in another plane of motion
- palpation is important in diagnosis
- most important is the fact that it follows the type II mechanics
- can have stacked multiple type II SD
- occur suddenly
- usually the patient is in an extreme position and tries to move in another plane of motion
- palpation is important in diagnosis
- most important is the fact that it follows the type II mechanics
- can have stacked multiple type II SD
76
How do we diagnose type I and type II dysfunctions?
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77
"What is Fryette's third law?"
- instate motion in any plane
- this will modify the movement in other planes of motion
- ex: cervical
- this will modify the movement in other planes of motion
- ex: cervical
78
What are the SPs rule of 3s?
"![]()
"
79
What are the joints of atypical vertebrae?
"![]()
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80
"What are fryette's 3 laws?"
"![]()
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81
What are the 2 types of dysfunction?
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82
How do you do scoliosis testing?
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"
83
Why is knowledge of physiological motion important?
diagnosis: you need to know about normal motion to evaluate disturbances of motion
treatment: it allows you to be specific while treating joint restrictions in all planes and axes
treatment: it allows you to be specific while treating joint restrictions in all planes and axes
84
How is somatic dysfunction named?
is always named for its freed of motion
ex. named for the directions in which the vertebra or other joint can move most easily
(IMP!)
ex. named for the directions in which the vertebra or other joint can move most easily
(IMP!)
85
What is the sympathetic chain?
T1 to L2 bilaterally
exit with somatic motor axons via IV foramina; travel with somatic axons for much of their course
inferior to the head and neck of ribs
posterior to pleura
exit with somatic motor axons via IV foramina; travel with somatic axons for much of their course
inferior to the head and neck of ribs
posterior to pleura
86
What is the Texas twist?
"![]()
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87
What is viscerosomatic?
visceral problems affecting the soma
88
What is somatovisceral?
soma affecting the viscera
89
What is the somatic nervous system?
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90
What is the parasympathetic nervous system?
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91
What is the sympathetic nervous system?
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92
What are the horizontal diaphragms?
"1. tentorium cerebelli
2. thoracic inlet/outlet
3. respiratory diaphragm
4. pelvic diaphragm
5. plantar fascia/arches of feet
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"
2. thoracic inlet/outlet
3. respiratory diaphragm
4. pelvic diaphragm
5. plantar fascia/arches of feet
93
What are the longitudinal cables?
"- dural sleeve to S2
- longitudinal ligaments occiput-S2
- prevertebral, alar, buccopharyngeal fascia
- psoas major to lower extremity
- rectus abdominus, q. lumborum, internal/external obliques
- trachea, esophagus, pericardium on central tendon of diaphragm
- A/P lower extremity fascia
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"
- longitudinal ligaments occiput-S2
- prevertebral, alar, buccopharyngeal fascia
- psoas major to lower extremity
- rectus abdominus, q. lumborum, internal/external obliques
- trachea, esophagus, pericardium on central tendon of diaphragm
- A/P lower extremity fascia
94
What are the diaphragms?
"![]()
"
95
What model is assoc. with the respiratory diaphragm?
respiratory-circulatory
96
What is the other name for the respiratory diaphragm?
thoracoabdominal diaphragm
97
What are the functions of the respiratory diaphragm?
1. respiration: O2, CO2, pH, blood
2. lymphatic flow back into circulation
2. lymphatic flow back into circulation
98
What are the parts, support, transversing structures of the diaphragm?
"![]()
"
99
What are the mechanics of the diaphragm (inhalation/exhalation)?
"INHALATION
- diaphragm contraction downward
- decrease pressure, so volume increases
- air in
EXHALATION
- diaphragm relaxes upward
- increase pressure
- so volume decreases
- air out
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- diaphragm contraction downward
- decrease pressure, so volume increases
- air in
EXHALATION
- diaphragm relaxes upward
- increase pressure
- so volume decreases
- air out
100
Describe doming of the diaphragm
"well domed diaphragm = good contraction, good compliance in inhalation
if diaphragm is flattened or spastic, trouble with inhalation
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if diaphragm is flattened or spastic, trouble with inhalation
101
"How does the respiratory diaphragm act as a ""lymphatic pump""?"
"- affected by contraction fo the diaphragm and thoracic cage motion
- drainage of pleural sacs and lung tissues is to the pre-tracheal nodes and then to the right lymphatic duct
- assists in fighting infection (tissue immunity)
- prevents tissue congestion
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- drainage of pleural sacs and lung tissues is to the pre-tracheal nodes and then to the right lymphatic duct
- assists in fighting infection (tissue immunity)
- prevents tissue congestion
102
How does the diaphragm act during respiration?
"![]()
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103
Where is the thoracic inlet?
"![]()
"
104
What is the inn. to coccygeus?
anterior rami S3-4
105
What is the innervation to levator ani?
S3 to S4 via inferior rectal n
106
What forms levator ani?
pubococcygeus
puborectalis
iliococcygeus
puborectalis
iliococcygeus
107
What forms the pelvic diaphragm?
levator ani and coccygeus muscles
108
What forms the floor of the pelvic cavity?
pelvic diaphragm
109
What fascial elements support the pelvis?
"pubovesical ligament
transverse cervical (cardinal)
uterosacral
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transverse cervical (cardinal)
uterosacral
110
Where is the tentorium cerebelli?
"the process of the Dura mater supporting the occipital lobes and covering the cerebellum.
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111
Where is the plantar fascia?
"bottom of foot
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112
What are the quadrants of the abdomen?
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113
What are the general categories of a visceral differential diagnosis?
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114
What layers are palpated in the abdominal wall?
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115
What must be noted on abdominopelvic palpation?
rigidity, rebound, guarding
abdominal wall (hernias, masses)
layer palpation of organ
abdominal wall (hernias, masses)
layer palpation of organ
116
How do you use OMT for organ problems?
"![]()
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117
What are the sympathetic pre-ganglionics?
Greater T5-9
Lesser T10-11
Least T12
Lumbar L1-2
Lesser T10-11
Least T12
Lumbar L1-2
118
What does the celiac ganglion innervate?
distal esophagus, liver, stomach, gallbladder, spleen, portions of pancreas, proximal duodenum
foregut
foregut
119
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
midgut
midgut
120
What does the inferior mesenteric ganglion inn.?
distal 1/3 transverse colon, descending colon, sigmoid, rectum, lower ureter, bladder, genitalia
hindgut
hindgut
121
What things must you note on initial examination?
- gross deformity
- muscle asymmetry
- skin changes (rash, erythema, ecchymosis)
- edema
- muscle asymmetry
- skin changes (rash, erythema, ecchymosis)
- edema
122
In a posterior examination, what landmarks should you note for symmetry?
- iliac crests
- waist crease
- greater trochanter
- pelvic position (no shift)
- hip position (not in flexion/extension)
- foot position
- waist crease
- greater trochanter
- pelvic position (no shift)
- hip position (not in flexion/extension)
- foot position
123
What should you note on gait to ensure symmetry?
check for:
- limp
- stiffness
- antalgic gait
- limp
- stiffness
- antalgic gait
124
What bony landmarks can be palpated posteriorly?
"iliac crests
PSIS
greater trochanter
gluteal lines
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"
PSIS
greater trochanter
gluteal lines
125
What muscles of the lower extremity can be palpated?
"![]()
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126
What are the ROM exercises of the hip?
"note when you turn the leg laterally you are testing the medial hip joint
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127
What is the normal ROM of the hip?
"![]()
"
128
What is the FABERE Test?
"flexion
abduction
ext. rotation
extend
make a 4
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abduction
ext. rotation
extend
make a 4
129
What is a positive FABERE test?
pain at the SI joint or hip joint
130
What is the Trendelenburg sign?
"drooping of contralateral hemipelvis below its normal horizontal level during monopedal stance
caused by weakness or paralysis of the gluteus medius and minimus muscles
innervated by the superior gluteal muscle
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caused by weakness or paralysis of the gluteus medius and minimus muscles
innervated by the superior gluteal muscle
131
What are travell trigger points?
"just know that referred pain can occur
even though pain is in one place, pain can occur elsewhere
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even though pain is in one place, pain can occur elsewhere
132
What muscle energy manipulations can be done for the psoas/hip pain?
"note this is isometric - the muscle shouldn't move
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133
What are the psoas stretching exercises?
"left is modified for person who can't kneel
Left picture is stretching L. psoas
Right pictures is stretching R. psoas
important to stay upright! lean forward with contralateral leg and extend ipsilateral (pain) leg
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Left picture is stretching L. psoas
Right pictures is stretching R. psoas
important to stay upright! lean forward with contralateral leg and extend ipsilateral (pain) leg
134
What are the guidelines for giving exercise instruction?
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135
What are the gluteal strengthening exercises?
"note from TL to bottom are different levels of difficulty depending on pts. strength
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136
What are the innominates?
"ilium, ischium, pubis.
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137
What are the 3 true pelvic ligaments?
"- anterior sacroiliac
- interosseus
- posterior sacroiliac
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- interosseus
- posterior sacroiliac
138
What are the accessory pelvic ligaments?
"- sacrotuberous
- iliolumbar
- sacrospinous
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- iliolumbar
- sacrospinous
139
What is the function the true pelvic ligaments?
restrain posterior, lateral, and axial rotation
140
What is the function of the accessory pelvic ligaments?
- restrain anterior movement and rotation
- also has role in vertical stability
- also has role in vertical stability
141
What are the muscles of the back with pelvic attachments?
"abdominal obliques
- internal - iliac crest
- external - iliac crest and pubic tubercle
erector spinae
- iliac crest
- ligaments
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"
- internal - iliac crest
- external - iliac crest and pubic tubercle
erector spinae
- iliac crest
- ligaments
142
What are the muscles of the anterior thigh with pelvic attachments?
"- adductors (attach to pubic bones)
- rectus femoris (origin is AIIS)
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- rectus femoris (origin is AIIS)
143
What are the muscles of the lateral thigh with pelvic attachments?
"Tensor fascia lata
attaches to ASIS and iliac crest
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attaches to ASIS and iliac crest
144
What are the muscles of the anterior back with pelvic attachments?
"quadratus lumborum
- O: iliac crest
- I: 12th rib
psoas
O: L1-4
I: lesser trochanter femur
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"
- O: iliac crest
- I: 12th rib
psoas
O: L1-4
I: lesser trochanter femur
145
What are the landmarks on the innominates?
"- PSIS
- ASIS
- pubic tubercle
- ischial tuberosity
- iliac crest
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- ASIS
- pubic tubercle
- ischial tuberosity
- iliac crest
146
What are the steps of the physical exam?
- gait
- structural asymmetry
- curvature of the spine
- postural balance
- motion testing
- structural asymmetry
- curvature of the spine
- postural balance
- motion testing
147
What tests are done with patient supine?
- hip flop
- medial malleoli levelness
- pubic bones
- ASIS levelness
- ASIS compression test
- medial malleoli levelness
- pubic bones
- ASIS levelness
- ASIS compression test
148
What is the hip flop test?
"- pt supine
- hips and knees bent
- pt lifts butt up and sets it down
- physician straightens legs
- pt. passive and relaxed
- check medial malleoli levelness
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- hips and knees bent
- pt lifts butt up and sets it down
- physician straightens legs
- pt. passive and relaxed
- check medial malleoli levelness
149
What is pubic symphysis evaluation?
"- hand palm caudad; fingers pointing cephalad
- walk hand down until contact with the bone
- place fingers cephalad on the pubic tubercles
- compare L to R side
this test would then need to be followed up with flexion test or ASIS test
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"
- walk hand down until contact with the bone
- place fingers cephalad on the pubic tubercles
- compare L to R side
this test would then need to be followed up with flexion test or ASIS test
150
What is an ASIS evaluation?
"compare L and R ASIS for symmetry
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"
151
What does the ASIS compression test examine?
"assess for restriction at the SI joint
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"
152
How would you perform an ASIS compression test?
"- pt. lying on asymptomatic side
- put iliac up on the side effected
- put hand on anterior rim of ilium and apply 3-6x thrusts downward pressure
- look to reproduce symptoms posteriorly
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"
- put iliac up on the side effected
- put hand on anterior rim of ilium and apply 3-6x thrusts downward pressure
- look to reproduce symptoms posteriorly
153
What tests are done with the patient prone?
- iliac crests
- PSIS
- iliolumbar ligaments
- ischial tuberosities
- sacrotuberous ligaments
- PSIS
- iliolumbar ligaments
- ischial tuberosities
- sacrotuberous ligaments
154
What posterior landmarks can be examined without a hip flop?
"- iliac crest
- PSIS
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"
- PSIS
155
Where is the ischial tuberosity?
- gluteal folds
- SITS bones
- sacrotuberous ligament attached
- SITS bones
- sacrotuberous ligament attached
156
What is the standing flexion test?
"- standing position feet shoulder length apart
- operator behind patient, eye level, with thumbs UNDER the PSIS
- patient bends forward
- motion restriction = PSIS moves cephalad
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"
- operator behind patient, eye level, with thumbs UNDER the PSIS
- patient bends forward
- motion restriction = PSIS moves cephalad
157
What does the standing flexion test evaluate?
gross evaluation of iliosacral motion
158
How would a positive standing flexion test evaluate?
motion restriction = PSIS moves cephalad
iliosacral dysfunction
contralateral tight hamstrings; sacroiliac dysfunction
iliosacral dysfunction
contralateral tight hamstrings; sacroiliac dysfunction
159
What is the seated flexion test?
"- patient is seated
- operator behind patient, eyes level and thumbs UNDER the PSIS
- same as standing flexion test
- removes innominates as factor
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"
- operator behind patient, eyes level and thumbs UNDER the PSIS
- same as standing flexion test
- removes innominates as factor
160
What does a seated flexion test evaluate?
sacroiliac dysfunction
161
What are the 3 pelvic motions?
- pubic motions
- iliac motions on the sacrum
- sacral motions on the ilium
- iliac motions on the sacrum
- sacral motions on the ilium
162
What are the pubic motions?
"- caliper
- torsional
- superoinferior translatory
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"
- torsional
- superoinferior translatory
163
What are the pubic dysfunctions?
- superior pubes
- inferior pubes
- abducted pubes
- adducted pubes
- inferior pubes
- abducted pubes
- adducted pubes
164
What is a superior pubic shear?
"- one pubic bone is displaced compared to the other
- etiology - tight rectus abdominus or trauma
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
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"
- etiology - tight rectus abdominus or trauma
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
165
What is an inferior pubic shear?
"- ASIS level or inferior
- PSIS level or superior
- etiology - tight adductors or trauma
treat:
flex knee up and put it into shoulder crease, flex up to barrier, patient applies opposite force
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"
- PSIS level or superior
- etiology - tight adductors or trauma
treat:
flex knee up and put it into shoulder crease, flex up to barrier, patient applies opposite force
166
What is pubic adduction?
"- suspicion of dysfunction by history
- bulging of pubic symphysis
- tenderness
- urinary symptoms
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"
- bulging of pubic symphysis
- tenderness
- urinary symptoms
167
What is abduction?
"- suspicion of dysfunction by history
- sulcus deeper than normal
- tenderness
- urinary tract symptoms
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"
- sulcus deeper than normal
- tenderness
- urinary tract symptoms
168
What are the types of ilial motion?
"![]()
"
169
What is anterior innominate rotation?
"- ASIS more inferior
- PSIS more superior
- ipsilateral hamstring tightness/spasm and sciatic are common complaints
- tissue changes at ILA os sacrum same side, as well as iliolumbar ligament tenderness
- freedom of motion anteriorly
etiology:
- hypertonic quads
- hypertonic QL
- hypertonic adductors
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"
- PSIS more superior
- ipsilateral hamstring tightness/spasm and sciatic are common complaints
- tissue changes at ILA os sacrum same side, as well as iliolumbar ligament tenderness
- freedom of motion anteriorly
etiology:
- hypertonic quads
- hypertonic QL
- hypertonic adductors
170
How would you correct anterior innominate rotation?
"rotate the ilium posteriorly
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"
171
What is posterior innominate rotation?
"- ASIS more superior
- PSIS more inferior
- inguinal/groin pain and/or medial knee pain
- inguinal tenderness and tissue changes at sacral sulcus
- freedom of motion posteriorly
Etiology:
hypertonic hamstrings
hypertonic rectus abdominus
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"
- PSIS more inferior
- inguinal/groin pain and/or medial knee pain
- inguinal tenderness and tissue changes at sacral sulcus
- freedom of motion posteriorly
Etiology:
hypertonic hamstrings
hypertonic rectus abdominus
172
How would you correct posterior innominate rotation?
"rotate ilium anteriorly
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"
173
What is a superior innominate shear?
"- ASIS more superior
- PSIS more superior
- pubic ramus more superior
- pelvic pain
- tissue changes at the ipsilateral SI joint and pubes
- motion freedom superior translation
etiology
- fall to the buttocks/knee - same side
- sitting/standing unevenly
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"
- PSIS more superior
- pubic ramus more superior
- pelvic pain
- tissue changes at the ipsilateral SI joint and pubes
- motion freedom superior translation
etiology
- fall to the buttocks/knee - same side
- sitting/standing unevenly
174
What is an inferior innominate shear?
"- ASIS more inferior
- PSIS more inferior
- pubic ramus inferior
- same complaint of pelvic pain
- same tissue changes
- RARE
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"
- PSIS more inferior
- pubic ramus inferior
- same complaint of pelvic pain
- same tissue changes
- RARE
175
What are innominate flares?
"ASIS medial or lateral to its usual position
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"
176
What is an innominate inflare v. outflare?
inflare - adducted; anterior rotation
out flare - abducted; posterior rotation
out flare - abducted; posterior rotation
177
How would you evaluate an innominate flare?
"- transverse line connecting the ASIS'
- then connecting each ASIS to the umbilicus
- visually connect the line from the umbilicus to the pubic bone
- examine the two triangles and find the flare
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"
- then connecting each ASIS to the umbilicus
- visually connect the line from the umbilicus to the pubic bone
- examine the two triangles and find the flare
178
How would you do HVLA for a superior shear?
"- pt. supine
- physician at foot of table
- grasp the patients lower leg above malleoli w/ both hands and apply traction
- keep hip in neutral
- internal rotate leg to take up tension
- slightly abduct
- instruct pt. to inhale and exhale, taking up slack with exhale
- final corrective force is a short quick pull on the leg
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"
- physician at foot of table
- grasp the patients lower leg above malleoli w/ both hands and apply traction
- keep hip in neutral
- internal rotate leg to take up tension
- slightly abduct
- instruct pt. to inhale and exhale, taking up slack with exhale
- final corrective force is a short quick pull on the leg
179
What are the innominates?
ilium, ischium, pubis. (acetab is all three)
180
What is the osteology of the sacrum?
"- lumbosacral facets
- five segments
- four coccygeal segments
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"
- five segments
- four coccygeal segments
181
What is it called when the lumbosacral junction contains transitional vertebrae?
- lumbarization
- sacralization
- sacralization
182
What is sacralization of L5?
"L5 fused with sacrum; hypermobility of L4 and up
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"
183
What is lumbarization of S1?
"Total or partial separation of S1 from sacrum
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"
184
"What is Ferguson's angle?"
"lumbosacral angle, 25-35 degrees
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"
185
Are there any direct muscular attachments to the sacrum?
NOPE
186
What are the true pelvic ligaments?
"- anterior sacroiliac
- interosseus
- posterior sacroiliac
restrain posterior, lateral, and axial rotation
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"
- interosseus
- posterior sacroiliac
restrain posterior, lateral, and axial rotation
187
What are the accessory pelvic ligaments?
"- sacrotuberous
- iliolumbar
- sacrospinous
restrain anterior movement and rotation, also has a role in vertical stability
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"
- iliolumbar
- sacrospinous
restrain anterior movement and rotation, also has a role in vertical stability
188
What nerves are assoc. with the sacrum?
sacral plexus
sacral parasympathetics
ganglion impar
sacral parasympathetics
ganglion impar
189
What nerves are included in the sacral plexus?
contain both motor and sensory in the pelvis and lower extremity
190
What nerves are assoc. with sacral parasympathetics?
S2-4
191
What is the ganglion impar?
is where the right and left sympathetic chains join and rests on the anterior surface of the coccyx
192
What are the landmarks of the sacrum?
"![]()
"
193
What are the transverse axes of rotation?
"- superior (S2 segment, assoc with respiratory and craniosacral motion)
- middle (located at anterior convexity, S2 sacral body, assoc. with postural flexion and extension)
- inferior (posterior inferior part of the inferior limb of the SI joint, assoc. with ilial rotation)
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"
- middle (located at anterior convexity, S2 sacral body, assoc. with postural flexion and extension)
- inferior (posterior inferior part of the inferior limb of the SI joint, assoc. with ilial rotation)
194
What are the oblique axes of rotation?
"- right
- left
assoc. with combination of 2 motions: side bending and rotation
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"
- left
assoc. with combination of 2 motions: side bending and rotation
195
What is the superior transverse axis?
"S2 segment
posterior to SI joint
respiration
craniosacral motion
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"
posterior to SI joint
respiration
craniosacral motion
196
What is the middle transverse axis?
"located at anterior convexity
S2 sacral body
postural flexion and extension
AKA: sacroiliac axis
![]()
"
S2 sacral body
postural flexion and extension
AKA: sacroiliac axis
197
What is the inferior transverse axis?
"posterior inferior part of the inferior limb of the SI joint
ilial (innominate) rotation
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"
ilial (innominate) rotation
198
What are the types of sacral motion?
Postural
- flexion extension
- rotation
- sidebending
- torsion
inherent
respiratory
dynamic
- flexion extension
- rotation
- sidebending
- torsion
inherent
respiratory
dynamic
199
How does the sacrum move in sacral flexion?
- base of the sacrum moves anterior for anatomic flexion
- motion is about the middle transverse axis
- motion is about the middle transverse axis
200
How does the sacrum move in sacral extension?
- anatomical extension - the base of the sacrum moves posteriorly
- movement is about the middle transverse axis
- movement is about the middle transverse axis
201
What axis does the sacrum rotate around?
occurs around a vertical axis
202
What axis does sacral side-bending occur around?
occurs around A-P axis
203
What does the standing flexion test evaluate?
"- gross evaluation of iliosacral motion
- standing position feet shoulder length apart
- operator behind patient with thumbs under the PSIS
- patient bends forward
- motion restriction = PSIS moves cephalad
![]()
"
- standing position feet shoulder length apart
- operator behind patient with thumbs under the PSIS
- patient bends forward
- motion restriction = PSIS moves cephalad
204
What is the seated flexion test?
"- evaluates sacroiliac dysfunction
- patient is seated
- operator behind patient, eyes level, and thumbs under the PSIS
- same as standing flexion test
- removes innominates as a factor
![]()
"
- patient is seated
- operator behind patient, eyes level, and thumbs under the PSIS
- same as standing flexion test
- removes innominates as a factor
205
What is the spring test?
"- tests for forward torsions
- patient prone
- heel of hands on the LS junction
- gentle but rapid force applied downward
- good spring = negative test
- poor spring = positive test
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"
- patient prone
- heel of hands on the LS junction
- gentle but rapid force applied downward
- good spring = negative test
- poor spring = positive test
206
What is a negative spring test?
negative = good spring
nice, normal, negative
nice, normal, negative
207
What is a positive spring test?
positive = poor spring
posterior, painful, positive
posterior, painful, positive
208
What is the sphinx test?
"palpate for sacral sulci
- deep
- shallow
ILA
- anterior
- posterior
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"
- deep
- shallow
ILA
- anterior
- posterior
209
How do you describe sacral torsion?
described relative to L5
210
What position is the sacrum in a forward sacral torsion?
flexed
211
What is a Left on Left torsion?
"- deep sulcus: right
- inferior/posterior ILA: L
- seated flexion: +R
- spring test: negative
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"
- inferior/posterior ILA: L
- seated flexion: +R
- spring test: negative
212
What is a Right on Right torsion?
"- deep sulcus: left
- inferior/posterior ILA: R
- seated flexion: +L
- spring test: negative
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"
- inferior/posterior ILA: R
- seated flexion: +L
- spring test: negative
213
What direction is the sacrum in a backward sacral torsion?
extended
214
What is a left on right sacral torsion?
"- deep sulcus: right
- inferior/posterior ILA: L
- seated flexion: + Left
- spring test +
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"
- inferior/posterior ILA: L
- seated flexion: + Left
- spring test +
215
In L/L and R/R sacral torsions, what general direction is the sacrum?
forward/flexed
216
What is right on left sacral torsion?
"deep sulcus: left
inferior/posterior ILA: R
seated flexion: + R
spring test +
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"
inferior/posterior ILA: R
seated flexion: + R
spring test +
217
What is the other name for unilateral sacral flexion?
left sacral shear
218
What is a left unilateral sacral flexion?
"deep sulcus: L
inferior/posterior ILA: L
seated flexion test +L
negative spring test
(right is opposite)
![]()
"
inferior/posterior ILA: L
seated flexion test +L
negative spring test
(right is opposite)
219
What is unilateral sacral extension (on L)?
"deep sulcus: R
inferior/posterior ILA: R
seated flexion test: +L
(right is opposite)
SPRING TEST +
![]()
"
inferior/posterior ILA: R
seated flexion test: +L
(right is opposite)
SPRING TEST +
220
What is the position of the sacrum in bilateral sacral dysfunction?
ILAs and sacral sulci are even
221
What is a bilateral flexed sacrum?
- motion decreased bilaterally
- sacrum flexes but is restricted in extension
- spring test negative
- seated flexion test is positive bilaterally
- sacrum flexes but is restricted in extension
- spring test negative
- seated flexion test is positive bilaterally
222
What is a bilateral extended sacrum?
- motion decreased bilaterally
- sacrum extends but is restricted in flexion
- spring test is positive
- sacrum extends but is restricted in flexion
- spring test is positive
223
What are the conventional models of medicine?
"Conventional Model
-Biology
-Chemistry
-(Physics/Math)
-Anatomy
-Physiology
-Pharmacology
-Surgery
-Psychiatry
![]()
"
-Biology
-Chemistry
-(Physics/Math)
-Anatomy
-Physiology
-Pharmacology
-Surgery
-Psychiatry
224
What is the expanded integrative model of medicine?
"All of the Conventional +
Biophysics
Consciousness
Spirituality
![]()
"
Biophysics
Consciousness
Spirituality
225
What model is used in osteopathic medicine?
"whole person model
![]()
"
226
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).
![]()
"
227
Draw the osteopathic philosophy, principles, and practice chart
"![]()
"
228
What models are based on biochemical/physical conventional medicine?
"interventional, symptomatic, emergency
![]()
"
229
What are the alternative paradigms seen in complementary/alternative medicine (CAM)?
"holistic, interdimensional, root cause
![]()
"
230
What is the clinical horizon?
"where disease will appear
![]()
"
231
Chart how clinical horizon will be altered with alternative medicine
"stay closer to healthy state
![]()
"
232
LIst conventional and alternative methods of medicines
"![]()
"
233
List methods of conventional and alternative physical therapy
"![]()
"
234
List methods of conventional and alternative psycotherapies
"![]()
"
235
What are the different type of botanicals used in medicine?
"1.Herbalism
A.Western
B.Chinese
C.Ayurvedic
2.Essential Oils
![]()
"
A.Western
B.Chinese
C.Ayurvedic
2.Essential Oils
236
What are the alternative systems of medicine?
"1.""Osteopathy""
2.Chiropractic
3.Naturopathy
4.Homeopathy
5.Oriental Medicine
6.Ayurveda
![]()
"
2.Chiropractic
3.Naturopathy
4.Homeopathy
5.Oriental Medicine
6.Ayurveda
237
List the different types of energy medicine
"1.OMT (Dynamic Strain-Vector Release, Neurofascial Release, others)
2.Acupuncture
3.Qi Gong
4.Reiki
5.Therapeutic Touch/Healing Touch
6.Pranic Healing
7.Marma Therapy
8.Jin Shin
9.Chakra Therapies
10.Magnetic Therapies
11. Polarity Therapy
12. Zero Balancing
13. PEMF, TENSCAM and other devices
Acoustic (Sound) Therapies
-Music Therapy
-Tomatis Method
-Other
14. Color Therapies
-Art Therapy
-Colorpuncture
-Laser therapy
![]()
"
2.Acupuncture
3.Qi Gong
4.Reiki
5.Therapeutic Touch/Healing Touch
6.Pranic Healing
7.Marma Therapy
8.Jin Shin
9.Chakra Therapies
10.Magnetic Therapies
11. Polarity Therapy
12. Zero Balancing
13. PEMF, TENSCAM and other devices
Acoustic (Sound) Therapies
-Music Therapy
-Tomatis Method
-Other
14. Color Therapies
-Art Therapy
-Colorpuncture
-Laser therapy
238
What are medicines that use manipulation and therapeutic bodywork
"1.""OMT""
2.Craniosacral Therapy™
3.Chiropractic manipulation
4.Therapeutic Massage
5.Trigger Point Myotherapy
6.Rolfing
7.Reflexology"
2.Craniosacral Therapy™
3.Chiropractic manipulation
4.Therapeutic Massage
5.Trigger Point Myotherapy
6.Rolfing
7.Reflexology"
239
What are the different movement therapies?
"1.""OMT""
2.Craniosacral Therapy™
3.Chiropractic manipulation
4.Therapeutic Massage
5.Trigger Point Myotherapy
6.Rolfing
7.Reflexology"
2.Craniosacral Therapy™
3.Chiropractic manipulation
4.Therapeutic Massage
5.Trigger Point Myotherapy
6.Rolfing
7.Reflexology"
240
What are the different mind-body therapies?
"1.Biofeedback
-EEG (""Central"")
-""Peripheral""
2.Hypnosis
3.Guided Imagery
4.Energy Psychology
5.Shamanism
6.Meditation
7.Prayer
![]()
"
-EEG (""Central"")
-""Peripheral""
2.Hypnosis
3.Guided Imagery
4.Energy Psychology
5.Shamanism
6.Meditation
7.Prayer
241
What are the different pharmacologc/biologic therapies?
"1.Chelation Therapy
2.Prolotherapy
3.Platelet Rich Plasma (PRP)
4.Stem Cell Therapies
![]()
"
2.Prolotherapy
3.Platelet Rich Plasma (PRP)
4.Stem Cell Therapies
242
What are the different types of nutrition therapy?
"1.Diets
2.Orthomolecular Medicine (Supplements)
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"
2.Orthomolecular Medicine (Supplements)
243
Compare osteopathy vs. chiropractic
"Osteopathy first class 1892 (Kirksville, MO)
Chiropractic first class 1896 (Davenport, IA)
A.T. Still, MD and D.D. Palmer knew each other (studied ""magnetic healing"" with Paul Caster, Ottumwa, IA)
Palmer visited Still at A.S.O. prior to starting chiropractic
![]()
"
Chiropractic first class 1896 (Davenport, IA)
A.T. Still, MD and D.D. Palmer knew each other (studied ""magnetic healing"" with Paul Caster, Ottumwa, IA)
Palmer visited Still at A.S.O. prior to starting chiropractic
244
Read the following article
"http://jaoa.org/article.aspx?articleid=2094619
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"
245
What are the 3 main types of chiropractors?
"1.""Straight"" - focus on spinal subluxations
2.""Mixers"" - utilize other treatments like nutrition, other types of physiotherapy
3.Network Spinal Analysis (NSA) or ""Network Chiropractic""- Donald Epstein, DC
![]()
"
2.""Mixers"" - utilize other treatments like nutrition, other types of physiotherapy
3.Network Spinal Analysis (NSA) or ""Network Chiropractic""- Donald Epstein, DC
246
What is emphasized by naturopathy?
"Emphasizes ""Natural Healing""
Nutrition, prevention, herbalism, manipulation, homeopathy, acupuncture, colon hydrotherapy"
Nutrition, prevention, herbalism, manipulation, homeopathy, acupuncture, colon hydrotherapy"
247
How many naturopathic schools are found in the US?
7 accredited schools
248
Who founded naturopathy?
"Benedict Lust
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"
249
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)
2. Symptoms a sign that body is striving to eliminate toxins, return to homeostasis
3. Holistic approach, body, mind, spirit, social
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"
2. Symptoms a sign that body is striving to eliminate toxins, return to homeostasis
3. Holistic approach, body, mind, spirit, social
250
What is homeopathy?
"treating like with like
![]()
"
251
What did samuel hahnemann do?
"founder
Experimented with low doses of quinine (antimalarial), noting his reactions to it.
Found that each time he took a minute dose, would get symptoms of malaria; stopping dose, Sx resolved.
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"
Experimented with low doses of quinine (antimalarial), noting his reactions to it.
Found that each time he took a minute dose, would get symptoms of malaria; stopping dose, Sx resolved.
252
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.
Tested hundreds of substances on himself (samuel hanhnemann) and others, developing symptoms of illness = ""provings"""
Tested hundreds of substances on himself (samuel hanhnemann) and others, developing symptoms of illness = ""provings"""
253
what is the law of similars in homeopathy?
"Prescribing minute doses of a substance (remedy) that causes similar symptoms of the illness.
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"
254
What is the law of cure of homeopathy?
Law of Cure = Remedies work from
1. Top to bottom
2. Inside to outside
3. From major organs to minor organs
4. Symptoms clear in reverse order of appearance
1. Top to bottom
2. Inside to outside
3. From major organs to minor organs
4. Symptoms clear in reverse order of appearance
255
What is included in oriental medicine?
"A system of healthcare:
• At least 3,000 years old
• Developed in the East (China)
• Includes:
- Herbalism
- Nutrition
- Acupuncture
- Massage (Tui na)
- Exercise
![]()
"
• At least 3,000 years old
• Developed in the East (China)
• Includes:
- Herbalism
- Nutrition
- Acupuncture
- Massage (Tui na)
- Exercise
256
What are the different models of oriental medicine?
"![]()
"
257
What is ayureveda?
"""Science of Life""
A system of healthcare:
At least 5,000 years old (?oldest)
Developed in India
Science
Philosophy
Spirituality
![]()
"
A system of healthcare:
At least 5,000 years old (?oldest)
Developed in India
Science
Philosophy
Spirituality
258
What are the 5 basic elements and 3 basic principles of ayurveda?
"![]()
"
259
What are the possible prescriptions of ayurveda?
"![]()
"
260
What is Wu Wei?
"no action out of harmony with nature
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"
