OS Exam 2 Flashcards
How many cervical vertebra do we have
7
The atlas lacks what vertebral structure
Has no vertebral body
What is the atypical feature of C2
Dens (odontoid process)
Articular facets in the cervical spine are oriented in what direction
Superior: upward toward eye
Inferior: point toward opposite shoulder
C2-c7 follow what type of mechanics
type II
From a lateral view. We can check alignment along what imaginary lines
Anterior vertebral line
Posterior vertebral line
Spinolaminar line
Posterior spinous line
What view must you use for x ray of the dens
AP (anteroposterior view) with an open mouth
What do we think is the cause of cervical spine somatic dysfunction
Compensatory after for dysfunction of lower parts of spine
Rotational testing in the. Cervical spine. Requires us to contact lateral mass (lateral to spinous process) and rotate them in what plane
Transverse plane
If you induce a force in the transverse plane on the left lateral mass what motion are we inducing in cervical vertebra
Rotate right
Translation of cervical vertebra (lateral segment movement: left to right or right to left) induces motion in which plane
Coronal plane
If we move a cervical vertebra in the coronal plane: translation from left to right what do we document this motion as
Sidebent left
If there is more restricted motion in the cervical vertebra while the neck is flexed how would we name it
Extension dysfunction
Which part of the chart should include documentation of somatic dysfunction
Objective portion (of SOAP note)
Normal flexion of the neck
45-90
Normal extension of the neck
45-90
Normal side bending of the neck
45
Where do we palpate while checking cervical ROM actively and passively
At the C7-T1 junction
Normal rotation of the neck
70-90
What are the major motions of OA joint
Flexion and extension (Sagittal plane motion)
What type of mechanics are displayed at the OA joint
Flex/extend but SB/Rot to opposite directions ALWAYS making it modified type I
To assess restriction of motion at the OA joint contact posterior occipital with middle finger and lateral aspect with index finger. Assess rotation right by lifting anterior on which side?
Left
To assess restriction of motion at the OA joint contact posterior occipital with middle finger and lateral aspect with index finger. Assess side bending left by inducting what motion?
Translation
antlantoaxial joint (AA) has what primary motion
Rotation (atlas rotates around dens)
To assess restriction of motion at the AA joint contact posterior occiput and place fingers on AA joint. Fully flex the head and neck to take out inferior segments. In this position we can check what motions for restriction?
Rotate right and left
We must assess OA and AA joint restriction of motion in what positions?
Neutral, flexed, and extended
We can also translate left or right in the sagittal plane at C3-7 by placing our fingertips where before inducing lateral motion
Tip of transverse process
Floor of thoracic cavity
Diaphragm
3 parts of sternum
Manubrium, body, xiphoid
The xiphoid remains cartilaginous until when
- Years
The head of rib 6 articulates with what structure on vertebra?
Inferior costal facet of T5 AND Superior costal facet T6
The transverse costal facets on transverse processes of vertebra articulate with what
Rib tubercle of the same numbered rib
Ligament holding head of rib into costal facets of adjacent vertebra
Radiate ligament
Rib tubercle held in place by what ligaments
Superior, lateral, Intertransverse and costotransverse ligament
Thoracic and lumbar vertebra follow Fryette’s laws of what type
Both type I (N, group of vertebra) and type II (F or E, one segment)
Main motion of thoracic spine
Rotation (because of ribs we can’t do much else)
Where in the spine can we do the most rotation? Second most?
Most- AA joint
Second most- thoracic vertebra
Why can we flex more than extend in thoracic spine
Because of the natural kyphotic curve
Where do we find sympathetic ganglion
Paravertebral ganglia of sympathetic trunks
Visceral distrubance often causes increased musculoskeletal tension in somatic structures innervated from the same spinal level. How can we reduce somatic afferent input thus reducing somatosympathetic activity to the organ
OMT treatment! treat at the transverse process that is tense
Which spinal segments correspond to sympathetics that supply the head and neck
T1-4
Which spinal segments correspond to sympathetics that supply the heart
T1-5
Which spinal segments correspond to sympathetics that supply the lungs
T2-7
Which spinal segments correspond to sympathetics that supply the upper abdominal viscera (stomach, liver, gallbladder, spleen, pancreas, duodenum)
T5-9
Which spinal segment corresponds to spine of scapula? Inferior angle of scapula?
T3 for spine
T7 for inferior angle
Which spinal segments correspond to sympathetics that supply the lower abdominal viscera (Pancreas, duodenum, jejunum, ilium, proximal and 2/3 of transverse colon)
T10-11
Which spinal segments correspond to sympathetics that supply the remainder of lower abdomen (distal 1/3 transverse colon, descending colon, sigmoid colon, rectum)
T12-L2
Which rib articulates posteriorly with cephalon border of scapula
Rib 1
Which rib anteriorly articulates with manubriosternal junction
Rib 2
Which rib attaches posteriorly at the level of the scapular spine
Rib 3
Which rib anteriorly attaches to xiphoid thermal junction and posteriorly at inferior angle of scapula
Rib 7
Which rib has cartilage at lowest part of thoracic cage at midclavicular line
Rib 10
Which are the true ribs (attach to sternum via own costal cartilage)
1-7
Which are false ribs (cartilage connected to those above before connecting to sternum)
8-10
Which ribs are floating (no eternal attachment
11-12
Which ribs are “typical” (with head neck tubercle and body)
3-9
What makes rib 1 atypical?
Single facet on head since it articulates with only T1, groove for subclavian artery and vein, scalene tubercle for anterior scalene attachment
What makes rib 2 atypical?
Tuberosity for serratus anterior
What makes rib 10-12 atypical?
Single facet on head because they articulate with ONLY ONE vertebra
What makes rib 11-12 atypical?
No neck or tubercle
What is the motion of ribs that is analogous to flexion / extension (rib 1-6 moves anteriorly)
Pump handle motion
What is the motion of ribs that is analogous to abduction/ adduction (rib 1 and 7-10 moves laterally)
Bucket handle motion
What is the motion of ribs that is analogous to internal/ external rotation (rib 11-12 pivoting because they have no anterior attachment)
Caliper motion
How would you characterize a dysfunction of ribs where the anterior ribs lift during inhalation and then remain there during exhalation
Inhalation Pump handle dysfunction (causes narrowing of intercostal space. Above dysfunction)
How would you characterize a dysfunction of ribs where the ribs don’t lift laterally during inhalation
Exhalation bucket handle function
If a rib has an inhalation dysfunction, which rib is the key rib to treat in this dysfunction
Lowest rib in dysfunction
If a rib has an exhalation dysfunction, which rib is the key rib to treat in this dysfunction
Uppermost rib in dysfunction
What is the number 2 reason for patient to go to doctor
Lower back pain
Majority of back pain does not require surgical intervention. Most of this pain is due to what?
Mechanical dysfunction
What can be some mechanical and non mechanical causes of low back pain
Mech: arthritis, spondylosis, spondylolisthesis, degenerative disc disease, somatic dysfunction
Non-mech: renal colic, endometriosis, abdominal aortic aneurysm
What motion do lumbar vertebra most easily do
Flexion and extension (because of the orientation of superior and inferior facets)
What is sacralisation of L5
Fusion of L5 to sacrum
What is lumbrasation of S1
Looseness of S1 from sacrum causes it to act like a lumbar vertebra
Flexion occurs in what plane
Sagittal
Rotation occurs in what plane
Transverse plane
In what plane does side bending occur
Frontal plane
When you flex lumbar spine what happens at sacral spine
Extension (they are moving in opposite directions)
How do we remember the directionality of type I mechanics
TONGO (type one neutral group opposite) side bending and rotation occur in opposite directions
What is a scotty dog fracture? (We know it occurred because our scotty dog has a collar)
Pars interarticularis fracture or separation- spondylolysis (if this is present bilaterally then sponlylolysthesis aka slippage anteriorly is more likely)
Which muscles maintain type II mechanics in lumbar spine
Short restrictors (multifidus, rotators, interspinales, intertransversaris)
What happens when you herniate a disc in the vertebra
Nucleus pulposus leaks through annulus fibrosus and can compress the spinal cord
Type one mechanics of spine are maintained by what muscles
Long restrictors (iliocostalis, longissimus, spinalis)
Dermatome covering anteromedial thighs and knee
L4
Dermatome converting posterolateral thigh and lateral leg
L5
Dermatome covering posterior thigh, leg, and plantar foot
S1
Knee jerk tests what spinal segment reflex
L4
Ankle jerk (achilles reflex) tests what spinal segment reflex
S1
what are the cauda equina symptoms that serve as red flags for lower back pain
Saddle anesthesia, new onset of bladder or bowel dysfunction, neurological symptoms that are severe or progressive
Red flags for low back pain
Over 50 or under 20, history of cancer, past trauma, cauda equina symptoms, constitutional symptoms
What are constitutional symptoms that serve as red flags in low back pain
Fever, chills, unexplained weight loss, recent bacterial infection, IV drug abuse, immunosuppression, nighttime pain severe
Failure of lamina to fuse causes what condition
Spina bifida (usually because of neural tube defects)
What do we give moms to prevent spina bifida in their kiddos
Folate
Which form of spina bifida causes tuft of hair near l5-s1 and is asymptomatic
Occulta
What type of spina bifida forces meninges of spinal cord out into vertebral spaces
Meningocele
What type of spina bifida forces meninges and spinal cord of spinal cord out into vertebral spaces
Myelomeningocele
Spinal cord terminates where
L1-L2
What conditions can compromise spinal canal via stenosis
Posterior longitudinal ligament hypertrophy, ligamentum flavin thickens, osteoarthritis, osteophytes, tumors, disc rupture
What are tender points that act as clues for visceral dysfunction (palpable small smooth, firm nodule)
Chapman reflexes
Chapman checks what anterior points for the little nodules
Periumbilical area (adrenal, kidney, bladder)
5th intercostal (stomach liver)
6th (stomach, liver, gallbladder)
7th (spleen, pancreas)
Chapman checks what posterior points for the little nodules
Kidney, bladder, urethra, uterus, colon, pelvic organs
What is something we need to be careful and aware of with LBP management?
Drug addiction is real- Try not to get your patients addicted to the good good (narcotics)
According to the rule of 3’s where can you find spinous process for T1-T3
At the same level of the corresponding transverse process
According to the rule of 3’s where can you find spinous process for T4-T6
Located 1/2 segment below corresponding transverse process
According to the rule of 3’s where can you find spinous process for T7-T9
Located 1 spinal segment below the corresponding transverse processes
According to the rule of 3’s where can you find spinous process for T10
Located 1 spinal segment below the corresponding transverse processes
According to the rule of 3’s where can you find spinous process for T11
Located 1/2 spinal segment below the corresponding transverse processes
According to the rule of 3’s where can you find spinous process for T12
Located at the same level as the corresponding transverse processes
T5-9 transverse processes correspond to the sympathetics that innervate what visceral structures
Stomach, liver, gallbladder, spleen, part of pancreas and duodenum
T10-11 transverse processes correspond to the sympathetics that innervate what visceral structures
Part of. Pancreas and duodenum, jejunum, Ilium, ascending. Proximal and 2/3 of. Transverse. Colon
T12-L2 transverse processes correspond to the sympathetics that innervate what visceral structures
Distal 1/3 transverse colon, descending and sigmoid colon, rectum
Intercostal spaces are named according to the rib forming which of their borders
Superior (so 4th intercostal space is between ribs 4-5)
What is the name of the space and nerve running inferior to T12
Subcostal
Which muscles help during inhalation
External intercostals, diaphragm
What muscles help us exhale
Rectus abdominus, internal and external obliques, transverse abdominis
Accessory muscles of inhalation and exhalation
Inh: SCM, scalene
Exh: passive recoil
Dysfunction of the thoracic wall can increase risk of atelectasis. What is atelectasis?
Complete or partial lung collapse
Why can rib fractures cause. Increased risk of atelectasis and infection??
Rib fracture causes pain with inhalation so patients stop taking deep breaths and this can cause alveoli to collapse
Pinpoint tenderness at Costochondral junction can indicate costodhondritis which we treat how?
NSAIDS, OMM (rib, thoracic spine, sternum, lymph treatment)
Latrogenic affects are those brought on by medical procedures. What procedures can cause rib dysfunction?
Thoracotomy
Lobectomy
Sternotomy (done in conjunction with CABG)
Sympathetic innervation that supplies the thyroid comes from which spinal segments
C6-t1
Sympathetic innervation that supplies the bronchus comes from which spinal segments
T2-3
Sympathetic innervation that supplies the lung comes from which spinal segments
T1-6
Sympathetic innervation that supplies the pleura comes from which spinal segments
T1-11
Sympathetic innervation that supplies the heart comes from which spinal segments
T1-5
Sympathetic innervation that supplies the myocardial septa comes from which spinal segments
T2
Sympathetic innervation that supplies the myocardial anterior wall comes from which spinal segments
T3-4
Sympathetic innervation that supplies the myocardial posterior wall comes from which spinal segments
T4-5
Sympathetic innervation that supplies the myocardial arrhythmia comes from which spinal segments
T2
Sympathetic innervation that supplies the chronic cardiac disease comes from which spinal segments
C5-7
Sympathetic innervation that supplies the stomach comes from which spinal segments
T5-9 (left)
Sympathetic innervation that supplies the duodenum comes from which spinal segments
T10 (right)
Sympathetic innervation that supplies the gallbladder comes from which spinal segments
T9 right
Sympathetic innervation that supplies the liver comes from which spinal segments
T5-9. Right
Sympathetic innervation that supplies the pancreas comes from which spinal segments
T6-9
Sympathetic innervation that supplies the kidney and ureters comes from which spinal segments
T10-l1
Sympathetic innervation that supplies the ovaries/ testes comes from which spinal segments
T10-l1
Sympathetic innervation that supplies the adrenals comes from which spinal segments
T10-l1
Sympathetic innervation that supplies the appendix comes from which spinal segments
T11-l2 right
Sympathetic innervation that supplies the uterus comes from which spinal segments
T10-L2
Sympathetic innervation that supplies the urinary bladder/ prostate comes from which spinal segments
L1-2
Sympathetic innervation that supplies the colon comes from which spinal segments
T8-L2
Sympathetic innervation that supplies the rectum/ anus comes from which spinal segments
L1-2
Parasympathetic innervation that supplies the viscera from pharynx to descending colon comes from where
Vagus nerve
Parasympathetic innervation that supplies the viscera from descending colon to pelvic organs comes from where
Sacral plexus (S2-4)
TART indicates somatic dysfunction. what does TART stand for?
Tissue texture changes
Asymmetry
Restriction of Motion
Tenderness
what are acute vs chronic Tissue Texture findings?
acute: warm, moist, red, inflamed, boggy muscle, increased muscle tone/ spasm
chronic: cool, pale, increased sympathetic tone, ropy muscle, faccid muscle
whats the term describing: abnormal shortening of muscle due to fibrosis
contracture
what are acute vs chronic Restriction of Motion findings?
acute: sluggish (guarding)
chronic: limited, painless ROM
what kind of abnormal end feel is associated with protective spasm after injury
early muscle spasm
what kind of abnormal end feel is associated with chronic muscle spasm
late muscle spasm
what kind of abnormal end feel is associated with frozen shoulder
hard capsular
what kind of abnormal end feel is associated with synovitis (such as knee swelling after injury)
soft capsular
what are acute vs chronic tenderness findings?
acute: sharp, severe
chronic: dull, ache, paresthesias
expected PROM for hip flexion
90
expected PROM for hip extension
15-30
which portion of the chart would include somatic dysfunction
objective portion (note the side of laterality)
expected PROM for hip external rotation
40-60
expected PROM for hip internal rotation
30-40
expected PROM for hip abduction
45-50
expected PROM for hip adduction
20-30
expected PROM for knee internal rotation
10
expected PROM for knee external rotation
10
what type of force do you apply when accessing abduction of the knee joint
varus
what type of force do you apply when accessing adduction of the knee joint
valgus
what do we do to access proximal fibula at the knee joint
with thumb and index finger, apply anterior and posterior force to assess for gliding motion of fibular head
what motions do we need to check for glenohumoral stability
shoulder flexion (180), extension(60), abduction(180), adduction(40-50), internal and external rotation(both 90)
how can one assess the rotational ability of the acromioclavicular joint
while the pt is in 60 degree of both coronal and horizontal abduction, internally and externally rotate the glenohumeral joint
what motion occurs in the sternoclavicular joint when the patient is lying supine, shoulders flexed to 90 and then they reach toward the ceiling
proximal clavicle moves posteriorly (horizontal flexion)
(horizontal extension of sternoclavicular joint occurs when shoulders return to neutral- proximal clavicle moves anterior)
most common dysfunction of sternoclavicular joint
horizontal extension dysfunction (restriction to horizontal flexion )
how can you assess abduction of the clavicle
place index fingers on superior aspect of the head of both clavicles and have patients shrug their shoulders– proximal end of clavicle moves inferiorly
how can you assess adduction of the clavicle
place index fingers on superior aspect of the head of both clavicles and from a shrugged position, have patient relax shoulders to neutral– proximal end of clavicle moves superiorly
describe horizontal flexion of the sternoclavicular joint
proximal clavicle moves posteriorly (when pt lies supine and reaches toward ceiling)
describe horizontal extension of the sternoclavicular joint
proximal clavicle moves anteriorly (when pt lies supine and relaxes shoulders from a position of reaching toward the ceiling)
when proximal clavicle moves inferiorly
abduction
when proximal clavicle moves superiorly
adduction
which muscles are responsible for scapular elevation
upper trapezius, levator scapulae
which muscles are responsible for scapular depression
middle trapezius, rhomboids
which muscles are responsible for scapular protraction
serratus anterior
which muscles are responsible for scapular retraction
rhomboids, middle trapezius
which muscles are responsible for scapular upward rotation
serratus anterior, upper trapezius
which muscles are responsible for scapular downward rotation
levator scapulae, rhomboids, latissimus dorsi
what does TONGO stand for
Type One (somatic dysfunction of thoracic spine) Neutral Group Opposite (side bending and rotation)
what type of force do we use to evaluate the thoracic spine for PTP (posterior transverse processes)
load and spring
if there is no change in end feel between flexed and extended positions when evaluating for PTP’s then what can we assume
the dysfunction follows Type I Mechanics
what can be used to evaluate side bending at each segmental level
translatory glide
if a segmental level has ease of translation from left to right that would indicate what
L SB (left side bending dysfunction)
in a seated position how can we evaluate side bending at the thoracic vertebra
examiner pushes down on patients shoulder with one hand and monitors side bending of the ipsalateral transverse process with the other hand
how can we evaluate rotational motion of thoracic vertebra from a seated position
examiner induces rotation by pulling shoulder girdle posterior and pushing anteriorly on ipsilateral transverse process
ease of motion relative to side bending and rotation would be palpated as opposite in what type of dysfunction
neutral (type I)
what are we looking for when we assess thoracic vertebra in flexion or extension
type II dysfunction (SB and R to same side)
what does it mean if segment improves or rotational end feel becomes more symmetric in flexion
flexion Type II dysfunction
what kind of dysfunction can live in the lateral malleolus
restriction to gliding (anterior or posterior)
expected ROM for dorsiflexion
15-20
expected ROM for plantar flexion
50-65
dorsiflexion and plantar flexion: motion is occurring between what bones
talus and tibia/ fibula
how do we check talus dysfunction
plantar flexion and dorsi flexion
how do we check calcaneus dysfunction
inversion and eversion
how do we avoid excess laxity in subtalar joint when checking for calcaneal dysfunction
place ankle in standing position (dorsiflex to 90 degrees between tibia and foot)
expected ROM for inversion
35
expected ROM for eversion
20
what do we call motion occurring between talus and calcaneus
subtalar motion
expected ROM for subtler inversion
10
expected ROM for subtler eversion
10
what motions of the navicular bone must we check for dysfunction
plantar and dorsal glide
what is the more common kind of navicular dysfunction
plantar glide dysfunction
if the patient has a dorsal navicular dysfunction what is that commonly associated with
tight plantar fascia
what motions of the cuboid bone must we check for dysfunction
plantar and dorsal glide
what is the more common kind of cuboid dysfunction
plantar glide dysfunction
what motions of the cuneiform bone must we check for dysfunction
plantar and dorsal glide
what is the more common kind of cuboid dysfunction
plantar glide dysfunction
what motions of the metatarsal bone must we check for dysfunction
plantar and dorsal glide
what is the more common kind of metatarsal dysfunction
plantar glide dysfunction
what motions must be checked for dysfunction at the metatarsophalangeal joints
plantar/dorsiflexion, adduction/abduction, internal/external rotation
how do we check abduction and adduction of the wrist
place wrist into supination and radial deviate (abduct) then ulnar deviate (adduct)
the thumb can be abducted by moving it anteriorly when the hand is supine and adducted by moving it posteriorly in the same position. where does the thumb like to live?
abduction
what kind of motion occurs in rib 1
50% bucket, 50% pump
what kind of motion occurs in rib 2
primarily pump handle
which rib (in a group dysfunction) is key to address with treatment for INHALATION dysfunction
most inferior
lets say ribs 1-2 on the left delay moving into inhalation position while right side moves into inhalation easily (both move into exhalation just fine) how do you name the dysfunction?
left ribs 1-2 exhalation group, pump handle somatic dysfunction
what kind of motion occurs in ribs 3-6
mixed pump and bucket handle (more inferior = more bucket handle… rib 6 is 50/50)
where do you palpate ribs 3-10 to assess for somatic dysfunction
with ulnar aspect of hand contact costochondral junction bilaterally
which rib (in a group dysfunction) is key to address with treatment for Exhalation dysfunction
most superior
what kind of motion occurs in ribs 7-10
mainly bucket handle
what kind of motion occurs in ribs 11-12
caliper motion
how do we position patient to assess motion of ribs 11-12
patient prone
restriction of motion in ribs 11-12 is influenced by what muscle
quadratus lumborum
what kind of force do we apply to the ulna to test ulnar abduction
valgus
what kind of force do we apply to the ulna to test ulnar adduction
varus
a posterior radial head dysfunction will have ease of motion to posterior glide and ___
pronation
an anterior radial head dysfunction will have ease of motion to anterior glide and ___
supination
