OPP FINAL Flashcards
What plane and axis does ROTATION occur on?
Transverse Plane
Vertical Axis
What plane and axis does SIDEBENDING occur on?
Coronal Plane
Anterior-Posterior Axis
What plane and axis does FLEXION occur on?
Sagittal Plane
Transverse Axis
What plane and axis does EXTENSION occur on?
Sagittal Plane
Transverse Axis
The spinous process of T8 moves superiorly with which motion of the T8 vertebra?
FLEXION
The LEFT transverse process of T5 moves posterioly with which motion of the T5 vertebra?
LEFT ROTATION
Which Fryette law is responsible for a group curve?
TYPE 1
Which Fryette Law?
a single vertebra that exhibits asymmetry in flexion or extension, with sidebending and rotation to the SAME sides
TYPE 2
This cervical joint always exhibits sidebending and rotation in OPPOSITE directions
OCCIPITOATLANTAL joint
C0 C1
This cervical joint only exhibits ROTATION
Atlantoaxial Joint
C1 C2
What cervical joint exhibits rotatino and sidebending to the SAME side
Joints of Luschka
C2 – C7
Facet Orientation
Cervical, Thoracic, and Lumbar Spine
BUM BUL BM
Three adjacent vertebra have posterior TPs on the left and they exhibit worse asymmetry in flexion and extension. What type of dysfunction are they?
TYPE 1 – group curve
What is made up of three parts: spinalis, longissimus, and iliocostalis and EXTENDS and ipsilaterally sidebends the spine
ERECTOR SPINAE
Short Restrictors are likely to create what type of fryette dysfunction?
rotatores, levatores costarum, interspinalis, and intransversarii
type 2
Long Restrictors are likely to create what type of fryette dysfunction
Multifidus, semispinalis thoarcis, spinalis, longissimus, iliocostalis
TYPE 1
What is the main muscle of the lumbar spine which provides stability?
MULTIFIDUS
These somatic dysfunctions you may see asssociated to what muscle?
Inhalation dysfunction (rib 12), L1-L4
Superior Shear of the innominate
Iliolumbar ligament tightness/tenderness
Hypertonic Quadratus Lumborum
When the psoas muscle goes into SPASM what what happenes to the lumbar spine?
FLEXION
Fryette Type 2 dysfunction
What 3 major structures pierce the diaphragm?
Aorta
Inferior Esophagus
Inferior Vena cava
These somatic dysfunctions are associated to?
L1,2,3 somatic dysfunctions
Lower 6 Rib somatic dysfunction
Thoracic somatic dysfunction of the lower 6 thoracic vertebrae
Diaphragmatic tightness
Ipsilateral or Contralateral?
Internal Obliques
External Obliques
Internal – Ipsilateral
External – Oblique
The orientation of what facet of a vertebra determines spinal motion?
SUPERIOR Facets
What is the preferred motion of the lumbar spine?
FLEXION and EXTENSION
BM
Right Left AXIS
Sagittal Plane
What is the preferred motion of the Thoracic Spine?
ROTATION
BUL
Superior-Inferior Axis
Transverse Plane
Etiologies of what?
Ruptured or herniated Disk
Bone or Cord tumors
Exostoses (bOne spurs)
Spinal Stenosis
Infection and Inflammation
Systemic Dx – Diabetes Mellitus
RADICULOPATHY
Patient comes in complaining of unilateral pain below the knee
Dull, burning, or lancing
Lumbar Radiculopathy
Where are herniations most frequent?
L4-L5
At what segment does the spinal cord end?
L2
A herniated disc (HNP) will typically affect the nerve root named for the segment ABOVE or BELOW?
BELOW
a herniated L5-S1 disc will affect which nerve root?
S1
Due to large central disc herniation or other space- occupying lesion compressing the cauda equina
Bilateral or unilateral sciatica
Saddle anesthesia
Lower extremity weakness
Cauda Equina Syndrome
Neurologic Exam for Radiculopathy
Deep tendon reflexes with patient seated
Patellar(?)
Achilles (?)
Patellar(L4)
Achilles (S1)
Motor function testing of lower extremities
Hip flexors(?)
extensors(?)
Hip flexors(L1-L2) extensors(L4-L5)
Motor function testing of lower extremities
Knee flexors (?)
extensors(?)
Knee flexors (L5-S1)
extensors(L3-L4)
Motor function testing of lower extremities
Dorsiflexion (?)
plantarflexion (?)
Great toe extension(?)
Dorsiflexion (L4-L5)
plantarflexion (S1-S2)
Great toe extension(L5-S1)
What are these associated to?
Psoriatic arthritis
Ankylosing Spondylitis
Inflammatory Bowel Disease
Reactive Arthritis (aka Reiter’s Syndrome)
PAIR
Ankylosing spondylitis
FLATTENED in AP curvature
What joint is first affected in patients with Ankylosing spondylitis
Sacroiliac Joint
What antigen is diagnosed in about 90% patients with Ankylosing spondylitis
HLA-B27
What is the diagnosis?
Congenital increase in thoracic A-P curvature
Vertebral body grows unevenly; see wedging of vertebrae
Scheuermann’s disease
What segments are most commonly affected in patients with Scheuermann’s disease
T7-T10
What disease is associated with wedge factures?
Osteoporosis
Whats the diagnosis?
Most common fx. at T12 and apex of thoracic spine
“Dowager’s hump”
Osteoporosis
Patients with a flattened lumbar curvature typically have a non neutral dysfunctional at what segments?
L1-L2
Patients that have a psoas spasm with sacral torsion usually have:
Backward Sacral Torsion
3. Contralateral Piriformis Spasm
4. Contralateral Sciatic Nerve Irritation
Spondylolisthesis is secondary to what kind of fracture?
Pars interarticularis
Reversing the Curve
This is commonly caused by
Spasms of paraspinal muscles
**Must treat INDIRECTLY
in acute settings/rule out fracture
prior to OMT
Numbness, tingling, weakness, or bowel and bladder dysfunction suggest what?
nerve root or spinal cord injury
Pain which radiates down the leg, below the knee seen in patients with :
Herniated Lumbar discs
Pain which is worsened by changes in position vs. exertion is likely ______
Pain with deep breathing without shortness of breath is likely _____
SOMATIC
outward curve vs inward curve
Outward = KYPHOTIC - thoracic
Inward = LORDOTIC – lumbar
facetogenic pain is felt in what type of movements
Extension and rotation movements
Lumbosacral pain is felt in what sort of movements
Upon standing and sitting
Differential Diagnosis of What region
R/o cauda equina, malignancy
Dx. of the spine/facets
Muscular: Quadratus lumborum, psoas, paraspinals
Ligamentous: Iliolumbar ligament, interspinous, A/P longitudinal
Neural: Sciatic and cluneal nerve
LUMBAR REGION
Differential diagnosis for what region?
R/o fracture, malignnacy, multiple myeoloma
Consider osteoporotic or traumatic compression fracture/causes of osteoporosis
Consider visceral causes
* Aortic dissection, MI, pneumonia, pneumothroax, pericarditis, hepatobiliary dx referral pattern
* nephrolithiasis or renal disease
THORACIC Region
scolosis is named for direction of what
CONVEXITY
scolosis severity greater than 50 degrees compromises what, and at 75 degrees
50 - resp function
75 - cardiovascular function
Osteopathic considerations
How do the vertebrae rotate and sidebend in regards to convexity
rotate INTO
sidebend AWAY from convexity
osteopathic considerations
How do the ribs on the convex and concave side move
Convex – seperate and move posterior
Concave – closer and anterior
* disc spaces narrow on concave side
What is the most clincially relevant element of short leg syndrome biomechanics
Sacral Base Unleveling
spine compenstates – rotoscoliosis
innominates rotate to compensate
Early Compensation of Short Leg Syndrome
The head and should depress to which side
Sacral Base, Iliac Crest and Spinal Convexity tilt towards what side?
Shoulder depresses opposite the side of pelvic depression
Sacrum, Iliac Crest and Spinal Convexity are on the side of the SHORT LEG
Guiding principles for progressive compensation
Which way do the innominates on the short side vs long side rotate
Short Side rotates ANTERIORLY to LENGTHEN
Long Side rotates POSTERIORLY to SHORTEN
iliolumbar ligament on which side of the short leg syndrome becomes stressed
on the side of the CONVEXITY
What OMT treatment option can be utilized if patient has an anatomic short leg (growth or trauma)
Heel Lift Therapy
Flexible spine – 3mm heel lift
Fragile spine – 1.5mm
LIFT THERAPY
If the patient had a sudden loss of leg length on one side and the pt had a level sacral base prior to developing the short leg, how much do you lift
lift the FULL fractional amount that was lost
Most common location of compartment syndrome
Anterior compartment of lower leg
As compartment pressure rises, what happens to venous outflow and venous pressure?
Venous outflow DECREASES
Venous Pressure INCREASES
DEC in arteriovenous pressure gradient
Pathogenesis of Compartment Syndrome
What gets released due to hypoxia
release of vasoactive substances
serotonin, histamine – allows capillatires to release more fluid in already tight compartment
What happens sooner nerve ischemia or muscle ischemiA
NERVE ischemia – after one hour
What is the most common measurement technique for compartment syndrome
Stryker Device
Simple Needle Manometer system
The wick
silt catheter
overuse injury that typically affects young endurance athelets. result from inc pressure within muscle compartments
Chronic Exertional Compartment Syndrome CECS
What is the prevalance of fibromyalgia in the US/Canada
2%
What neurotransmitter is inhibitory in the pain pathway?
GABA
How many tenderpoints are needed to establish a diagnosis of fibromyalgia using the 1990 ACR criteria?
11
