OPP review 1 Flashcards
Osteopathic structural examination reveals a positive seated flexion test on the right, a shallow right sacral sulcus, a deep left inferior lateral angle, and a positive lumbosacral spring test. The most likely intersegmental dysfunction present at L5 is
Flexed SDL RL
A 10-year-old female presents to the office with the complaint of headaches. History reveals the patient was hit in the left ear during a softball game six months prior. There were no neurological deficits after the injury and a CT of the head was negative. Physical examination reveals tenderness and restriction over the coronal suture on the left. The most appropriate osteopathic manipulative technique for the patient’s somatic dysfunction is
V-spread technique is the most appropriate osteopathic technique for treating isolated somatic dysfunctions at any cranial suture.
What is the indication for a parietal lift?
The parietal lift is used to correct dysfunction chiefly in the squamous suture. Gentle traction is applied upward to “lift” the parietal bone relative to the rest of the skull. This technique does not address the coronal suture.
Chapman point for appendix Anterior Posterior
Anterior tip of the 12th rib on the right. Posterior T11 intertransverse space. Treatment of a Chapman’s point consists of firm rotary motion over the point.
Sixth intercostal space mid clavicular on the right
This is the anterior Chapman’s point for the gallbladder. It would be present in cholecystitis
While palpating the cranium in the vault hold, you notice that the greater wings of the sphenoid seem to shift to the right, while base of the sphenoid deviates left in relation to occiput. What strain pattern is this?
Left Lateral strain Named for the base
When treating with an “Articulation technique” what structure must be stabilized? Ex: L2 FRLSL,
In seated articulatory technique to the lumbar spine, the vertebra BELOW the dysfunctional segment must be stabilized: using the torso as a lever. Dysfunctional vertebra is L2 so L3 should be stabilized at the spinous process. If you were treating this in the lateral recumbent position, utilizing the legs as the lever, you would stabilize L2 to move L3 through full range of motion in order to treat the L2 segment. Remember that when diagnosing L2 dysfunction, you are really diagnosing dysfunction in how well L2 articulates on L3.
On physical examination, there is a chronic, fibrotic appearance to the thoracolumbar fascia on the right, with an ease in cephalad and clockwise motion. You decide to treat with direct myofascial release treatment. What is the correct treatment position?
Going direct means going into the restriction. Since “ease” is cephalad and clockwise, you go the opposite the engage the dysfunction. Apply a force down to the fascial layer and hold caudad and counterclockwise until a release is felt.
Mneumonic BITE
Bottom Inhalation top exhalation
For a pt who is T4 to T8 neutral, side-bent right, rotated left with HVLA,
What is the correct hand placement and vertebral segment to address first when performing supine, short-lever, rotational emphasis HVLA for T4 to T8 neutral, side-bent right, rotated left?
Right thenar eminance under the Pt T6 Transverse process.
The physician side-bends the patient left, down to the T6-T7 junction, and the side-bending and rotation forces are localized at the T6 fulcrum by adjusting accordingly
(HVLA) T1:
- Treat the middle vertebral segment in the first.
- T6 should be addressed first when performing HVLA.
- HVLA of the mid-thoracic vertebrae and ribs–>Kirksville crunch
- Uses thenar eminence of the opposite hand to localize and apply a HVLA thrust to the desired treatment area.
SF +L
ILA+ L
Sacral Sulcus R
Spring Tst +
What is L5 doing?
L torsion on right oblique axis
A 1-week-old male presents after requiring vacuum suction. Physical examination reveals a well-appearing infant with a parallelogram-shaped cranium with the base of the sphenoid deviated to the left in relation to the base of the occipital bone
What are the axes of rotation for the patient’s dysfunction at the sphenobasilar synchondrosis?
Question is asking what the axis for lateral strain is:
2 vertical axis
Physical examination reveals a well-appearing infant with a parallelogram-shaped cranium with the base of the sphenoid deviated to the left in relation to the base of the occipital bone.
left lateral strain
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You position the patient in the right lateral recumbent position and stand facing the patient. You position the patient’s left leg so that it drops over the side of the table. You rotate the patient’s left shoulder posterior towards the left and rotate the pelvis anteriorly, inducing further left rotation and right side-bending. After all slack is taken up, you induce a small thrust and find, after reassessment, that the somatic dysfunction has improved. What is the exact diagnosis for this patient’s L5 somatic dysfunction?
?
HVLA for Type I lumbar somatic dysfunctions:
Pt put lateral recumbent position involves positioning the patient rotational side down, dropping the upper leg off the table, rotating the pelvis anteriorly and the upper shoulder posteriorly. This induces opposite directions of rotation and side bending. In a Type II lumbar somatic dysfunction, the upper leg is dropped off the table with the foot in the popliteal fossa. The upper hip and shoulder are then approximated together to induce rotation and side bending the same direction.
The occipito-atlantal (OA) joint is restricted in translation to the left; however, sidebending is symmetric when the OA is placed in the extended position. The most likely diagnosis is
OA is extended and Sd L rotated right
Treatment for a right unilateral sacral flexion with ME
SF+R
DB+R
PILA+R
negative spring says flexion
Push anterior on the right ILA during inhalation
The right inferior lateral angle (ILA) is posterior and the right sacral base is anterior,
pushing anteriorly on the ILA would help to restore normal sacral motion. Furthermore, the sacrum extends during inhalation around a superior transverse axis and flexes during exhalation.
Physical examination reveals a positive standing flexion test on the right, posterior superior iliac spine (PSIS) is superior on the left, anterior superior iliac spine (ASIS) is inferior on the left, and the medial malleolus is more caudad on the left. The initial positioning for proper muscle energy treatment of this somatic dysfunction is
The proper positioning of a right posterior innominate would engage the restrictive barrier whether the patient is prone or supine by passively extending the right hip.
Where would the anterior tenderpoint for an L2 dysfunction be located?
Medial aspect of the AIIS
Remember this with the mnemonic MLB = major league baseball = medial, lateral, bottom. The L5 tenderpoint is located one centimeter lateral to the pubic symphysis on the superior ramus.
AIIS
L2=M
l3=L
l4= inferior
L1=medial ASIS
AL5 is lateral to pubic symphysis
NOTE Lymphatic treatment for a pt with CHF should include thoracic outlet first
Physical examination reveals a positive standing flexion test on the right, a right ASIS that is superior compared to the left, a left PSIS that is superior compared to the right, and a deep right sacral sulcus. Seated flexion test is normal bilaterally. The most likely diagnosis is
Right posterior inominant
A pt with DVT would have viscero-somatic reflex at what spinal level?
The is patients presentation is suspicious for DVT with PE and the lower extremity visceral somatic reflex should be a positive finding at the level of T11-L2.
Pt. that got hit with an uppercut to left jaw. What type of strain and axis.
How would you expect your index fingers and fifth digit to deviate when palpating using the vault hold in the supine position
Vertical strain on 2 transverse axis.
Superior VS.
Sphenoid is in flexion and occiput in extension.
Greater wing will be anterior and inferior.
Thus: Index finger will be inferior and fifth digit on the occiput will be superior
pt with right ankle pain.
Physical exam: tenderness over the anterior portion of the ankle that increases with dorsiflexion. Lower extremity strength, sensation, and reflexes are intact. An anterior drawer on the ankle is negative, and there is no ligamentous instability on exam. There is a significant decrease in dorsiflexion on the right compared with the left. There are no other notable restrictions. What somatic dysfunction is likely responsible for her symptoms?
A 38-year-old male presents to the office with the complaint of neck pain. History reveals the pain began after falling asleep sitting up while on an airplane. Physical examination reveals hypertonic tissues in the paraspinal muscles of the cervical region. Structural examination reveals the occipitoatlantal joint is restricted in translation to the right. Translation is symmetric in the extended position. The most likely diagnosis is
OA is extended sD R R left
Chapman point for kidney vs adrenal gland
Kidney:
1’superior and lateral to umbilicus
2’superior and 1’ lateral
On osteopathic structural examination, you note a positive left standing flexion test and positive left ASIS compression test. The right ASIS is more lateral from the umbilicus than the left.
To treat this patient’s somatic dysfunction with post-isometric relaxation muscle energy, the patient is positioned to the restrictive barrier of
Left hip external rotaion and Ab-duction
Given that this patient has an inflare, the patient’s barrier is external rotation and abduction. With the patient’s hip positioned at the barrier of external rotation and abduction, the patient is asked to push the knee medially into adduction and internal rotation.
A Foosh injury will result in what type of radial head dysfunction?
What is the patient falls back?
Posterior radial head–> stuck in pronation and posterior glide
Treatment: MET: Put to restriction barrier in supination. Ask patient to pronate arm then move to new supination barrier.
Anterior Radial head
edematous, erythematous, increased moisture, hypertonic muscles
Acute or Chronic?
Acute
Acute or Chronic?
cool dry skin, decreased muscle tone
Chronic
Acute or Chronic?
Range of motion may be normal but quality is sluggish
Acute
Acute vs Chronic
When palpating tissue
Acute: Tender/ Sharo
Chronic:
Dull achy
When treating a right anteriot rotated innominant with Muscle energy somatic dysfunction involves an isometric contraction what muscle group
right hip extensors
