OPP Review Powerpoint Flashcards
1
Q
What does TART stand for?
A
T: tissue texture changes
A: asymmetry
R: Restriction of motion
T: tenderness
2
Q
What is the difference between a physiologic and anatomic barrier?
A
Physiologic: point at which a patient can actively move a given joint
Anatomic: point to which a physician can passively move a given joint
3
Q
What is the difference in TART between acute and chronic somatic dysfunction?
A
Acute T: edema, erythema, boggy, moist, muscle tension A: present R: present and painful T: severe, sharp
Chronic T: no edema, no erythema, cool dry skin, decreased muscle tone, ropy, fibrotic A: present with compensation R: present, little to no pain T: dull achy, burning
4
Q
What is Freyette’s 1st law?
A
If the spine is in the neutral position, and if sidebending is introduced, rotation will then occur to the opposite side
NS(L)R(R)
Usually applies to more than two vertebral segments
5
Q
What is Freyette’s 2nd law?
A
If the spine is in the non-neutral position and rotation is introduced, sidebending will the occur to the same side
Always named for their freedom of motion
FR(R)S(R) ER(L)SL)
Law 1 and 2 only apply to the thoracic and lumbar vertebrae
6
Q
What is Freyette’s 3rd law?
A
Initiating motion at any vertebral segment in any one plane of motion will modify the mobility of that segment in the other two planes of motion
7
Q
What is the facet orientation of the cervical, thoracic, and lumbar regions?
A
Cervical: backward, upward, medial (BUM)
Thoracic: backward, upward, lateral (BUL)
Lumbar: backward, medial (BM)
8
Q
With motion in the spine (flex/ext, rotation, sidebending) which axis and plane do these motions correspond to?
A
Flex/ext: Axis: transverse Plane: Sagittal
Rotation: Axis: Vertical Plane: Transverse
Sidebending: Axis: Anterior-Posterior Plane: Coronal
9
Q
What is an Isotonic contraction?
A
Muscle contraction that results in the approximation of the muscle’s origin and insertion without a change in its tension (operators force is less than the patients)
10
Q
What is an isometric contraction?
A
Muscle contraction that results in the increase in tension without an approximation of origin and insertion (operators force is equal to patients force)
11
Q
What is an isolytic contraction?
A
Muscle contraction against resistance while forcing the muscle to lengthen (operators force is more than the patients force)
12
Q
What is a concentric contraction?
A
Muscle contraction that results in the approximation of the muscle’s origin and insertion
13
Q
What is an eccentric contraction?
A
Lengthening of muscle during contraction due to an external force
14
Q
Myofacial release is (direct/indirect/active/passive)?
A
Both active and passive and both direct and indirect
15
Q
Counterstrain is (direct/indirect/active/passive)?
A
Indirect and passive
16
Q
FPR is (direct/indirect/active/passive)?
A
Indirect and passive
17
Q
Muscle energy is (direct/indirect/active/passive)?
A
Direct (rarely indirect) and active
18
Q
HVLA is (direct/indirect/active/passive)?
A
Direct and passive
19
Q
Cranial is (direct/indirect/active/passive)?
A
Both direct/indirect and passive
20
Q
Lymphatic treatments is (direct/indirect/active/passive)?
A
Direct and passive
21
Q
Chapman’s Reflexes is (direct/indirect/active/passive)?
A
Direct and passive
22
Q
Function of Scalenes?
A
Unilateral contraction sidebends the neck to the same side, bilateral contraction flexes the neck
23
Q
Where do the anterior and middle insert and what is their function?
A
Anterior and middle insert onto rib 1 and help elevate rib 1 on forced inhalation
24
Q
Where do the posterior scalenes insert and what is their function?
A
Posterior inserts onto rib 2 and helps to elevate rib 2 during forced inhalation
25
What is the SCM's function?
Unilateral contraction will sidebend ipsilaterally and rotate contralaterally, Bilateral contraction will flex the neck
26
What is torticollis?
Torticollis is a shortening or restriction of the SCM
27
What are the joints of Luschka?
Formed by the uncinate processes on C3-C7, They help to support the lateral side of the cervical discs and protect cervical nerve roots from disc herniation, also known as uncovertebral joints, Most common cause of cervical nerve root pressure is degeneration of these joints
28
Where do nerves C1-C8 exit, above or below the vertebral body
above
29
Which nerve roots make up the Brachial plexus?
C5-T1
30
OA (motion)
Motion: flexion and extension
| Sidebending and rotation: opposite
31
AA (motion)
Motion: Rotation
| Sidebending and rotation: opposite
32
C2-C4 (motion)
Motion: Rotation
| Sidebending and rotation: same side
33
C5-C7 (motion)
Motion: Sidebending
| Sidebending and rotation: same side
34
What is the rule of 3’s?
T1-T3: spinous process located at the level of the corresponding transverse process
T4-T6: spinous process located one half a segment below the corresponding transverse process
T7-T9: spinous process located one segment below the corresponding transverse process
T10: same as T7-T9
T11: same as T4-T6
T12: same as T1-T3
35
Spine of the scapula (level)
T3
36
Inferior angle of the scapula (level)
T7
37
Sternal notch (level)
T2
38
Sternal angle (angle of Louis) (level)
T4
39
Nipples (level)
T4 dermatome
40
Umbilicus (level)
T10 dermatome
41
What is the main motion of the thoracic spine?
rotation
42
What are the attachments of the diaphragm?
Xyphoid process, Ribs 6-12, Bodies and intervertebral discs of L1-L3
43
Typical Ribs
3-10
44
Atypical Ribs
1,2,11,12
45
Why is Rib 1 atypical
Rib 1: only articulates with T1 and has no angle
46
Why is Rib 2 atypical?
Rib 2: has a large tuberosity on the shaft for attachment of serratus anterior
47
Why is Ribs 11,12 atypical?
Rib 11 and 12: articulate only with the corresponding vertebrae and lack tubercles
48
True Ribs
True: 1-7 attach to the sternum
49
False Ribs
False: 8-12 do not directly attach to the sternum
50
Floating Ribs
Floating: 11 and 12
51
What is the primary motion of ribs 1-5?
Pump handle
52
What is the primary motion of ribs 6-10?
Bucket handle
53
What is the primary motion of ribs 11 and 12?
Caliper
54
What is an Inhalation dysfunction?
Dysfunctional rib will move cephalad during inhalation
Dysfunctional rib will not move caudad during exhalation
Rib appears to be held up
55
What is an Exhalation dysfunction?
Dysfunctional rib will move caudad during exhalation
Dysfunctional rib will not move cephalad during inhalation
Rib appears to be held down
56
What is the key rib?
BITE:
Inhalation dysfunction the key rib is the lowest rib of the dysfunction
Exhalation dysfunction the key rib is the highest rib of the dysfunction
57
Why is disc herniation more likely to occur in the lumbar spine?
The posterior longitudinal ligament begins to narrow in the lumbar spine. At L4-L5 it is roughly one half the width as it is at L1.
58
In the thoracic and lumbar spine do the nerve roots exit from above or below the corresponding vertebrae?
Below
59
Which muscles make up the erector spinae group?
Spinalis, Iliocostalis, Longissimus
60
What is spina bifida occulta?
No herniation through the defect, May have patch of hair over the defect site, Rarely associated with neuro deficits
61
What is spina bifida meningocele?
A herniation of the meninges through the defect
62
What is spina bifida meningomyelocele?
Herniation of the meninges and the nerve roots through the defect, Associated with neuro deficits
63
What is the major motion of the lumbar spine?
Flexion/extension
64
What is a herniated nucleus pulposus?
98% occur between L4-L5 and L5-S1
Herniated disc in the lumbar spine will exert pressure on the nerve root of the vertebrae below, Pain in lower back and lower leg
May be sharp, burning or shooting pain into leg
May have associated weakness and decreased reflexes associated with affected nerve root
Less than 5% are surgical candidates
HVLA is contraindicated
65
What is Psoas syndrome?
Precipitated by prolonged positions in which the psoas is shortened
Pain in low back sometimes radiating to the groin
Increased pain when standing or walking
Positive thomas test
Do not initially treat with heat
Do not stretch acute spasms only stretch chronic spasms
66
What is spinal stenosis?
Narrowing of the spinal canal which puts pressure on the nerve roots
Pain in low back to lower legs or legs
Worsened by extension as when standing, walking, or lying supine
67
What is Spondylolisthesis?
Anterior displacement of on vert in relation to the one below
Usually at L4-L5
Achy pain in low back, buttock, posterior thigh
Increased pain with extension based activities
Grades 1-4 Dx with lateral X-ray
HVLA is contraindicated
68
What is spondylolysis?
Defect of the pars interarticularis without anterior displacement of the vertebral body
Seen with oblique view (collar on the scotty dog)
69
What is spondylosis?
Radiographical term for degenerative changes within the intervertebral disc and ankylosing of adjacent vertebral bodies
70
What is cauda equina syndrome?
Pressure on the nerve roots of the cauda equina usually due to a massive central disc herniation
Sharp pain in low back
Saddle anesthesia, decreased DTR, decreased rectal tone, loss of bowel and bladder control
Emergent surgical decompression is imperative
If delayed to long, irreversible paralysis may result
71
How is a scoliosis named?
To the side of the convexity
| If the curve is sidebent left then it is a right scoliosis
72
What is the difference between a functional and a structural curve?
Functional: spinal curve that is flexible and can be partially or completely corrected with sidebending to the opposite side
Structural: spinal curve that is relatively fixed and inflexible. Will not correct with sidebending to the opposite direction
73
What is a cobb angle and how does this relate to the severity of the scoliotic curve?
Cobb angle: A horizontal line is drawn from the vertebral bodies of the extreme ends of the curve. Perpendicular lines from these horizontal lines are formed and the cobb angle is the acute angle they form.
Mild: 5 to 15 degrees
Moderate: 20 to 45 degrees
Severe: >50 degrees
74
At what cobb angle do respiratory and cardio function become compromised?
Respiratory: >50 degrees
Cardio: >75 degrees
75
Who should be treated with heel lifts, and what are the guidelines for their use?
Used to tx short leg syndrome where femoral head difference is >5mm
The final heel lift should be 1/2 to 3/4 of the measured leg length discrepancy
The “fragile” pt. should begin with a 1/16”heel lift and increase 1/16” every two weeks
The “flexible pt can start with 1/8” and increase by 1/8” every two weeks
Max of 1/4” applied to inside of shoe, if more needed it must be applied to the outside of shoe
Max heel lift = 1/2”
76
What divides the greater and lesser sciatic foramen?
Sacrospinous ligament
77
What muscles make up the pelvic diaphragm?
Levator ani
| Coccygeus muscles
78
What are the five axis that the sacrum can move in?
```
Superior transverse axis
Middle transverse axis
Inferior transverse axis
Right oblique axis
Left oblique axis
```
79
Respiratory motion of sacrum
Occurs at superior transverse axis @S2. Inhalation the sacral base moves posterior
80
Craniosacral motion of sacrum
Superior transverse axis, sacral base counternutates with craniosacral flexion
81
Postural motion of sacrum
Middle transeverse axis, at terminal flexion sacral base moves posterior
82
Dynamic motion of sacrum
Two sacral oblique axis, during ambulation
83
Innominates move about the _____
Inferior trans axis
84
What are the three rules of sacral torsion relating to L5?
When L5 is sidebent, the sacral oblique axis is engaged on the same side as the sidebending
When L5 is rotated, the sacrum rotates the opposite way on an oblique axis
The seated flexion test is found on the opposite side of the oblique axis
85
```
Right deep sacral sulcus
Left ILA posterior and inferior
Lumbar curve convex to the right
Positive seated flexion on Right
Negative spring test
```
L on L
86
```
Right sacral sulcus shallow
Left ILA anterior and superior
Lumbar curve convex to the right
Positive seated flexion test on the Right
Positive spring test
```
R on L
87
```
Left sulcus deep
Right ILA posterior and inferior
Lumbar curve convex to the Left
Positive seated flexion test Left
Negative spring test
```
R on R
88
```
Right and Left sulci deep
ILA’s shallow bilaterally
Increased lumbar curve
False negative seated flexion test
Negative spring test
```
Bilateral sacral flexion
89
```
Left sulcus deeper
Left ILA inferior and posterior
Positive seated flexion on the left
Motion at the left sulcus is present
Motion at the left ILA is restricted
```
Left unilateral sacral flexion
90
```
Left sulcus shallow
Right ILA anterior and superior
Lumbar curve convex to the left
Positive seated flexion test on the left
Positive spring test
```
L on R
91
```
Right and left sulci shallow
ILA’s deeper bilaterally
Decreased lumbar curve
False negative seated flexion test
Positive spring test
```
Bilateral sacral extension
92
```
Right sulcus shallow
Right ILA superior and anterior
+ seated flexion on the right
Motion at the right sulcus is restricted
Motion at the right ILA is present
+ spring test
```
Right unilateral sacral extension
93
What is the most common sacral dysfunction in the post-partum patient?
Bilateral sacral flexion
94
What are the muscles that make up the rotator cuff?
Supraspinatus: abduction of the arm
Infraspinatus: external rotation
Teres minor: external rotation
Subscapularis: internal rotation
95
Arterial Supply to Arms
Subclavian art. Passes between ant and middle scalene
Subclavian-> axillary @ lateral border 1st rib
Axillary-> brachial @inferior border teres minor accompanied by radial nerve
Brachial-> radial and ulnar art.
Radial-> deep palmer arch
Ulnar-> superficial palmar arch
96
Which nerve roots make up the brachial plexus and what order do they divide down into branches?
C5-C8,T1
| Roots-> Trunks-> Divisions-> Cords-> Branches
97
What are the most common dysfunctions of the shoulder?
Most common is restriction to internal/external rotation, second is restriction to abduction, and the least common is restriction to extension
98
What is thoracic outlet syndrome and where are the 3 places it can occur?
Compression of the neurovascular bundle as it exits the thoracic duct
Ache or parasthesia in the neck or radiating into the arm
Compression points 1) between anterior and middle scalene 2) between the clavicle and the first rib 3) between the pectoralis minor and the upper ribs
99
Humeral dislocation usually occurs in which direction?
Anteriorly and inferiorly
100
What causes winging of the scapula?
Long thoracic nerve injury causes weakness of the anterior serratus muscle
101
What is Erb-Duchenne’s Palsy?
Most common form of brachial plexus injury due to damage of C5 and C6 nerve roots during childbirth
102
What is Klumpke’s palsy?
Injury to C8 and T1 which usually causes paralysis to the intrinsic muscles of the hand. Much less common
103
What is the most commonly injured nerve in the upper extremity?
The radial nerve. Injuries include crutch palsy, humeral fractures, and Saturday night palsy
104
What are the 8 carpal bones of the hand?
Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capate, hamate
105
What is the origin of the flexor muscles of the wrist and hand and innervation?
Origin: medial epicondyle
Innervation: median nerve (except flexor carpi ulnaris- ulnar nerve)
106
What is the origin of the extensor muscles of the wrist and hand and their innervation?
Origin: Lateral epicondyle
Innervation: radial nerve
107
What are the primary supinators of the arm and their innervation?
Biceps- musculocutaneous nerve
| Supinator- radial nerve
108
What are the primary pronators of the arm and their innervation?
Pronator teres and pronator quadratus both innervated by the median nerve
109
What is the innervation to the muscles of the thenar eminence?
Median nerve (except for adductor pollicis brevis- ulnar nerve)
110
What is the innervation to the hypothenar eminence and interossi?
Ulnar nerve
111
What is the innervation to the 1st and 2nd lumbricals and the 3rd and 4th lumbricals?
1st and 2nd: median nerve
| 3rd and 4th: ulnar nerve
112
Where does the flexor digitorum profundus and flexor digitorum superficialis attach to?
Profundus: DIP
Superficialis: PIP
113
What is the carrying angle?
Line drawn down humerus and line drawn up proximal radial ulna joint, acute angle they form is the carrying angle. Men is 5 degrees, women is 10 to 12 degrees. >15 is cubitus valgus or abduction of the ulna with adduction of the wrist, <3 is cubitis varus or adduction of the ulna with abduction of the wrist
114
When the forearm is pronated and supinated, which direction does the radial head move?
Pronate: radial head moves posteriorly
Supinate: radial head moves anteriorly
115
What is carpal tunnel syndrome and what nerve causes it?
Entrapment of the median nerve at the wrist
Pt usually complains of paresthesias on the thumb and first 2 1/2 digits
Reproduced by Tinel’s, phalens, and prayer tests
116
What is lateral epicondylitis (tennis elbow) and what nerve is involved with it?
Strain of the extensor muscles of the forearm near the lateral epicondyle
Result of overuse of the forearm extensors and supinators
Pt complains of pain over the lateral epicondyle that worsens with wrist extension against resistance
117
What is a swan-neck deformity?
Flexion contracture of the MCP and DIP
Extension contracture of the PIP
Associated with rheumatoid arthritis
118
What is Boutonniere deformity?
Extension contracture of the MCP and DIP
Flexion contracture of the PIP
Results from rupture of the hood of the extensor tendon at the PIP
Associated with RA
119
What is claw hand?
Extension of the MCP
Flexion of the PIP and DIP
Results from median and ulnar injury
120
What is ape hand?
Similar to claw hand
Wasting of the thenar eminence
Thumb is adducted
Damage to the median nerve
121
What is bishop’s deformity?
Contracture of the last two digits
Atrophy of the hypothenar eminence
Ulnar nerve damage
122
What is Dupuytren’s Contracture?
Flexion contracture of the MCP and PIP usually seen with contracture of the last two digits
Unlike bishop’s, this is due to a contracture of the palmar fascia
123
What is a drop wrist deformity?
Radial nerve damage results in paralysis of the extensor muscles
124
What direction will the head of the femur glide with internal and external rotation of the hip?
Internal: femural head glides posteriorly
External: femural head glides anteriorly
125
With pronation and supination of the foot, which direction will the fibular head glide?
Pronation: fibular head glides anteriorly
Supination: fibular head glides posteriorly
126
What three axis make up pronation and supination at the ankle?
Pronation: dorsiflexion, eversion, abduction
Supination: Plantarflexion, inversion, adduction
127
Which nerve roots make up the femoral nerve and what motor and sensory functions does it control?
L2-L4
Motor: quadriceps, iliacus, sartorius, pectineus
Sensory: anterior thigh, medial leg
128
What nerve roots make up the sciatic nerve and what motor and sensory functions does it control?
L4-S3
Comes through greater sciatic foramen
Tibial branch: motor- hamstrings (not short head of the biceps femoris), most plantar flexors, toe flexors sensory- lower leg, plantar aspect of the foot
Peroneal branch: motor- short head of biceps femoris, evertors, dorsiflexors of foot, extensors of the toes sensory- lower leg, dorsum of foot
129
What is the Q angle?
Formed by the intersection of a line from the ASIS through the middle of the patella and a line from the tibial tubercle through the middle of the patella
Normal Q= 10 to 12 degrees
Genu valgum= increased angle
Genu varum= decreased angle
130
Which nerve is directly posterior to the fibular head and therefore may be injured with trauma to the fibula?
Common peroneal
131
What is a compartment syndrome?
Result of trauma or vigorous overuse leading to increased intracompartmental pressure in one of the four lower leg compartments (lateral, deep posterior, superficial posterior, anterior-most often affected
Anterior tibilais muscle is hard and tender to palpation, stretching the muscle causes extreme pain
In severe cases without fasciotomy, the muscles may begin necrosis in 4 to 8 hours
132
What is O’Donahue’s triad (terrible triad)?
Most common knee injury
| Results in injury to the ACL, MCL, and medial meniscus
133
What are the bones of the foot?
Talus, Calcaneus, Navicular, Cuboid, 3 cuneiforms, 5 metatarsals, 14 phalanges
134
Is the ankle more stable in dorsiflexion or plantarflexion?
dorsiflexion
135
What are the three arches of the foot and which bones do they connect to?
Medial longitudinal: talus, navicular, cuneiforms, 1st to 3rd metatarsals
Lateral longitudinal: calcaneous, cuboid and 4th and 5th metatarsals
Transverse: navicular, cuneiforms, cuboid (arch where somatic dysfunction usually occurs)
136
What three ligaments are the lateral stabilizers of the ankle?
Anterior talofibular, Calcaneofibular, Posterior talofibular
137
The most commonly injured ligament in the ankle is?
Anterior talofibular ligament
138
What muscle is the primary flexor of the hip?
Iliopsoas
139
What muscle is the primary extensor of the hip?
Gluteus maximus
140
What is the primary extensor of the knee?
Quadriceps (rectus femoris, vastus lateralis, medialis, and intermedius)
141
What is the primary flexor of the knee?
Hamstrings (semimembranosus and semitendinosus)
142
Who developed the cranial field?
William Garner Sutherland D.O.
143
What makes up the primary respiratory mechanism (PRM)?
CNS, CSF, Dural membranes, Cranial bones, Sacrum
144
How often do cranial rhythmic impulses (C.R.I.) occur?
10 to 14 cycles per minute
145
Where does the dura mater attach to?
Foramen magnum, C2, C3, S2
146
Where is the keystone to all cranial movement?
Sphenobasilar synchondrosis (SBS), the articulation of the sphenoid with the occiput
147
What four things make up craniosacral flexion?
Flexion of the midline bones (sphenoid, occiput, ethmoid and vomer), Sacral base posterior (counternutation), Decreased AP diameter of the cranium, External rotation of the paired bones
148
What four things make up craniosacral extension?
Extension of the midline bones, Sacral base anterior (nutation), Increased AP diameter of the cranium, Internal rotation of the paired bones
149
What is a craniosacral torsion?
Twisting at the SBS
Anterior cranium rotates in one direction and the posterior cranium in the other in an AP axis
Named for the greater wing of the sphenoid that is more superior
Left sphenoid high= left cranial torsion
150
Describe a sidebending/rotation strain?
Sphenoid and occiput rotate in the same direction on an AP axis
Sphenoid and occiput will sidebend to the right or left on a vertical axis thus shifting the SBS to the side of the sidebending
151
What is a vertical strain?
Vertical strain occurs at the SBS when the sphenoid deviates cephalad (superior vertical strain) or caudad (inferior vertical strain) in relation to the occiput
152
What is lateral strain?
When the sphenoid deviates laterally in relation to the occiput. Named for the direction of deviation of the sphenoid
153
What is a compression strain of the SBS?
Occurs when the sphenoid and occiput have been pushed together
Can result in severely decreased C.R.I.
Usually due to trauma to the back of the head
154
What can be causes of vagal somatic dysfunction?
Dysfunction at the OA, AA, and or C2
155
What cranial conditions can lead to poor suckling in the newborn?
Occipital condylar compression (CN12)
| Dysfunction of CN 9 and 10 at the jugular foramen
156
What are the absolute and relative contraindication to craniosacral treatment?
Absolute: acute intracranial bleed, increased intracranial pressure, skull fracture
Relative: seizure hx., dystonia, traumatic brain injury
157
What is spinal facilitation?
Premotor neurons, motoneurons of preganglionic sympathetic neurons in one or more segments of the spinal cord are placed in a state of partial or sub-threshold excitation
Less afferent stimulation is required to trigger the discharge of impulses
Facilitation can be sustained by normal CNS activity
158
What three thing make up a reflex arc?
```
Afferent limb (sensory input)
Central limb (spinal pathway)
Efferent limb (motor pathway)
```
159
How does facilitation correlate with somatic dysfunction?
Abnormal or continuous sensory input from overstretched muscle spindle sensitizes interneurons
Reflex occurs so that muscle tension is produced-> decreased ROM & tenderness
Prolonged muscle tension causes nearby nociceptor activation which release substances which cause tissue texture change
Facilitated motoneurons cause an exaggerated motor response-> asymmetry
So, a facilitated segment may= TART
160
Head and neck
T1-T4
161
Heart
T1-T5
162
Respiratory system
T2-T7
163
Esophagus
T2-T8
164
Upper GI (stomach, liver, gallbladder, spleen, portions of the pancreas and duodenum)
T5-T9, Greater sphlanchnic nerve, Celiac ganglion
165
Middle GI (portions of the pancreas and duodenum, jejunum, ilium, ascending colon, proximal 2/3 of transverse colon)
T10-T11, Lesser splanchnic nerve, Superior mesenteric ganglion
166
Lower GI (Distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum)
T12-L2, Least splanchnic nerve, Inferior mesenteric ganglion
167
Appendix
T12
168
Kidneys
T10- T11, Superior mesenteric ganglion
169
Adrenal medulla
T10
170
Upper ureter
T10-11, superior mesenteric ganglion
171
Lower ureter
T12-L1, inferior mesenteric ganglion
172
Bladder
T11-L2
173
Gonads
T10-11
174
Uterus and cervix
T10- L2
175
Erectile tissue of penis and clitoris
T11-L2
176
Prostate
T12- L2
177
Arms
T2- T8
178
Legs
T11- L2
179
Parasympathetic innervation to all viscera above the diaphragm?
Vagus nerve
180
Parasympathetics to the entire small intestine?
Vagus nerve
181
What parasympathetics innervates the large bowel?
Ascending and transverse: vagus nerve
| Descending and sigmoid: pelvic splanchnic
182
What parasympathetics innervate the GU system?
Kidneys and upper ureter: vagus nerve
| Lower ureter and bladder: pelvic splanchnic
183
What parasympathetics innervate the reproductive system?
Ovaries and testes: vagus
| All others: pelvic splanchnics
184
What two landmarks divide up the GI tract?
Ligament of Treitz (duodenum and jejunum)
Splenic flexure (transverse and descending colon)
T5-T9 before ligament of treitz
T10- T11 between
T12- L2 after splenic flexure
185
What does L3- L5 innervate?
nothing
186
What are chapman’s points?
Anteriorly are smooth, firm, 2-3mm nodules within the deep facsia or on the periosteum of a bone
Posteriorly are usually located between the spinous and transverse processes and are rubbery
Gentle pressure will usually elicit sharp, nonradiating distressing pain
187
Appendix Chapman Point (CP)
Anterior: tip of the right 12th rib
Posterior: transverse process of T11 vertebrae
188
Adrenals (CP)
Anterior: 2” superior and 1” lateral to the umbilicus
Posterior: between spinous process and transverse process of T11 and T12
189
Kidney (CP)
Anterior: 1” superior and 1” lateral to the umbilicus
Posterior: T12- L1
190
Bladder (CP)
Periumbilical region
191
Colon (CP)
Lateral thigh within the IT band
Cecum: right proximal femur
Colon at hepatic flexure: Right distal femur
Sigmoid colon: left proximal femur
Colon at Splenic flexure: left distal femur
192
What is the difference between tenderpoints and triggerpoints?
Trigger points may refer pain when pressed, tenderpoints do not
193
What is the procedure for doing a myofacial release?
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Palpate restriction
Apply compression (indirect) or traction (indirect)
Add twisting or transverse forces
Use enhancers
Await release
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194
What are the goals of myofacial release?
Restore functional balance to all integrative tissues
| Improve lymphatic flow
195
What are the four physiologic diaphragms of the body?
Tentorium cerebelli
Thoracic outlet
Abdominal diaphragm
Pelvic diaphragm
196
Who first documented the common compensatory pattern?
J. Gordon Zink D.O.
197
What is the common compensatory pattern?
OA junction: rotated Left
Cervicothoracic junction: rotated Right
Thoracolumbar junction: rotated Left
Lumbosacral junction: rotated Right
198
What drains into the minor (right) lymphatic duct?
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Right upper extremity
Head and face (hemicranium)
Heart
Lungs (except the left upper lobe)
Remainder of body drains into left (major) duct
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199
Where do the right (minor) and left (major) drain into?
Right: right brachiocephalic vein
Left: junction of the left internal jugular and the subclavian veins
200
What structures bypass the lymphatics and drain directly into the thoracic duct?
Thyroid
Esophagus
Coronary and triangular ligaments of the liver
201
What are the extrinsic and intrinsic forces that influence lymphatic fluid movement?
Extrinsic: OMT, exercise, contraction of muscles, pulsations of adjacent arteries, respiratory movements
Intrinsic: Smooth muscle contraction, interstitial fluid pressure
202
What factor influence whether extracellular fluid enters the lymphatic capillary?
Increased arterial capillary pressure
Decreased plasma colloidal osmotic pressure
Increased protein in the interstitium
Increased capillary permeability
203
What are the relative contraindications to lymphatic treatments?
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Osseous fractures
Bacterial infections with a temperature >102
Abcesses or localized infections
Certain stages of carcinoma
Counterstrain and FPR
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204
Who pioneered counterstrain?
Lawerence H. Jones
205
What are the basic treatment steps in counterstrain?
Locate tenderpoint
Palpate the tenderpoint
Place patient in position of optimal comfort
Maintain this position for 90 seconds
Slow return to neutral (first few degrees most important)
Recheck (no more than 30% of tenderness should remain)
206
Where is the anterior tenderpoint for L5 located?
One cm lateral to the pubic symphysis on the superior ramus
207
Who developed FPR?
Stanley Schiowitz D.O.
208
Is FPR direct or indirect technique?
indirect
209
What is the typical FPR procedure?
Place patient in neutral position (decreasing kyphosis or lordosis)
Apply facilitating force (compression, torsion, both)
Shorten the muscle being treated
Hold 3-4 seconds
Release and recheck
210
What is postisometric relaxation (direct technique)?
Reverse all components in all planes and engage the restrictive barrier
Golgi tendon senses these changes in tension in the muscle tendons and causes a reflex relaxation of the agonist muscle fibers
211
What is reciprocal inhibition?
By contracting the antagonist muscle, signals are transmitted to the spinal cord and through the reciprocal inhibition reflex arc, the agonist muscle is then forced to relax
212
What are contraindication to using muscle energy?
Patients with low vitality who could be further compromised by adding active muscular exertion
Surgical patients
Intensive care patients
213
What kind of technique is HVLA?
Passive and direct
214
What are the absolute and relative contraindications of HVLA?
Absolute: osteoporosis, osteomyelitis, fractures in thrust area, bone mets, severe RA, Down’s syndrome
Relative: acute whiplash, pregnancy, post-surgical conditions, herniated nucleus propulsus, patients on anticoagulation therapy, vertebral artery ischemia
215
What are the major and minor complications of HVLA?
Minor: soreness, symptom exacerbation
Major: vertebral artery injury, cauda equina syndrome
