OS FINAL Flashcards
Are carrying angles greater in men/women?
women
Ulnar ABduction leads to a dec/inc in carrying angle
increase
Ulnar ADduction leads to a dec/inc in carrying angle
decrease
Flexion in elbow degrees and muscles
140-150
biceps and brachioradilais
extension in elbow
triceps 0- -5 degrees
supination muscles in elbow
supinator and biceps
pronation muscles in elbow
pronator teres and pronator quadratus, 90 degrees
strength scale
– 0-5
– 5 Full movement against normal resistance
– 3 Full movement against gravity
– 0 No movement
Ulnar Abduction testing
Provide a Valgus force at the Elbow, motion is coupled
with wrist ADduction
Ulnar ADduction Testing:
Provide a Varus Force at the Elbow, motion is coupled
with wrist ABduction
Reference point for dysfunction in elbow
distal ulna
ROM for arm
Flexion,Extension ,ADduction,ABduction
Flexion 80-90
• Extension 70
• ADduction (Ulnar Deviation): 30-40
• ABduction (Radial Deviation): 20-30
Wrist flexion motion is coupled with ____
dorsal carpal glide
wrist extension motion testing is coupled with ___
ventral carpal glide
Cervical Spine ROM for flexion extension, sidebending and rotation
Flexion 45-90°
Extension 45-90°
Sidebending 45°
Rotation 70-90°
C1:
Atlas
- No vertebral body
- Rotates around DENS
- OA Joint:
Atypical - Modified Type I Mechanics
- Can be F or E d/t shape
- Nicole’s trick: Type 1 = C1; Think TONGO → what changes? → N
Diagnosis of OA joint
Contact posterior aspect of occiput → assess in N, F, E
- Translation = SB
- Lifting anterior = R
AA (or C1-C2):
Atypical - Rotation ONLY
- Diagnosis:
- FULLY FLEX head/neck to take out rotatio nof vertebra below AA
- C2-7 mechanics
- Type 2 if single vertebrae
- modified type 2 if grouped
Dianosis for c2-c7 (rotational)
- Rotational - Rotoscloliosis testing
- Transverse plane
- Ex: push on Left lateral mass anterior → Right TP moves posteriorly = Rotated R
Dianosis for c2-c7 (translation)
- Translation - Moving segments laterally
- Coronal plane
- Ex: push Left to Right → Left ear to shoulder = SB L
- Do R and SB in N, F, E
- Documenting DTRs:
Normal: 2+/4
- 3 is BRISK
- 4 is CLONUS
- Segmental motion: cervical spine segments
OA - modified type 1
- AA - rotation only
- C2-C7 - modified type 2
DTR
Biceps: C5
- Brachioradialis: C6
- Triceps: C7
- Spurling’s Maneuver
3 stages: if symptoms are found at any stage → do NOT proceed to the next stage
- Neutral compression
- Extension compression
- SB away from affected side; SB toward affected side
- (+) = pain down the arm in nerve root compressed
OA joint- put fingers over ___ for lateral translation
occipital articulation
OA joint- put fingers over ____ for rotational test
occipital ridge
AA joint testing techniques
flex c spine to isolate atlas and do not test F,E, SB
C2-7- palpalte ____ for lateral translation
lateral borders of the articular pillars
Palate ___ for rotation of c2-7
posterior surface of articular pillars
PTP on L for c2-7 is what rotation
L rotation
Upper Cervicals- Towards eye
Lower Cervicals-Towards opposite ASIS (NOT in horizontal plane)
????
fucntion divisions of SNS
T1-4: sympathetic innervation to the head and neck (T1-6 (sic) heart and lungs)
■ T5-9: sympathetics to the upper abdominal viscera
■ T10-11: most of the lower abdominal viscera
■ T12-L2: the rest of the abdominal viscera (left colon and pelvic organs)
landmarks of thoracic vertebrae
○ T3: spine of scapula
○ Spinous process T7, transverse process
T8: inferior angle of scapula
○ T12: rib 12
Rule of 3
T1-3: Spinous process at the same level as the transverse processes
T4-6: SP halfway between the same TP and the one of the lower vertebra
T7-9: SP one level below TP of same vertebra
T10: same as T7-9
T11: same as T4-6
T12: same as T1-3
Wolff’s law
bones and soft tissue deform according to the stresses put on them
● Type 1 (TONGO):
○ No sagittal plane motion (neutral)
○ Sidebending and rotation are opposite
○ Groups of vertebrae
● Type 2:
○ Flexion or extension
○ Sidebending and rotation are the same
○ Singular units
where is rotation greatest in spine
Rotation greater in the T-spine than anywhere else besides the AA joint
what is sidebending limited by
ribs
Cat back is __
flexion
sphynx/tv watching is
extension
where would somatic dysfunction of T spine go in SOAP note
assessment
Attachment points for ribs
2-9 articulate above and below
1, 10-12 articulate only with the corresponding vertebrae
Landmarks for Rib 1
○ Anteriorly: inferior to the clavicle
○ Posteriorly: cephalad to the border of the scapula
Landmarks for rib 2
○ Articulates with the manubrium and body of the sternum
Landmarks for rib 3
○ Posteriorly: level of the scapular spine
Landmarks for rib 7
○ Anteriorly: xyphosternal junction
○ Posteriorly: level of the inferior angle of the scapula
landmarks for rib 10
○ Cartilage of the lowest part of the thoracic cage on the mid-clavicular line
typical ribs (which ones and characteristics)
(3-9)
● Head, neck, tubercle, and body are all thin
and flat
● Head has 2 facets for the costovertebral
articulations
● Tubercle articulates with the transverse
process at the costotransverse articulation
Rib 1 atypical because __
Flattest, shortest, and greatest curve
● Subclavian groove on the superior surface
● Head only articulates with T1
Rib 10 atypical because
● Only articulates with T10
ribs 11-12 atypical because ___
● No neck or tubercles
● Articulates only with associated vertebra
Pectoralis muscles can cause what with issues with breathing
inhalation dysfunction
muscles used in exhalation
normally none because passive, but when active: ● Rectus abdominus muscle; internal/external obliques; transverse abdominus
Pump handle motion
-ribs and movment
Rib 1 is 50%; Rib 2
○ Analogous to flexion/extension
○ Increase in A-P diameter
Bucket handle
-ribs and movement
○ Rib 1 is 50%; Ribs 7-10 predominant
○ Analogous to abduction/adduction
○ Increase transverse diameter
Calliper motion
-ribs and motion
Ribs 11-12
○ Analogous to internal/external rotation
○ Pivoting motion
ribs 3-6 motion
The lecture states that they are pump handle,
OSCE states mixed, with it being more pump
handle towards the upper ones and getting
progressively more bucket handle as you go
down
how to assess rib 1-2
● Bucket handle: thumbs on the angle of rib 1, forefingers in the supraclavicular fossa, over the superior lateral aspect of
rib 1
● Pump handle: forefinger posterior to clavicle on the superior aspect of rib 1, middle/ring finger on anterior aspect of rib
2
how to assess ribs 3-10
Bucket handle: contact midaxillary line of each rib with fingertips
● Pump handle: monitor at the costochondral margins with the ulnar aspects of each hand
how to assess ribs 11-12
Patient prone, use thumb and 2nd/3rd finger to monitor motion
● **Restriction of motion is due to quadratus lumborum muscle
elevated rib 1 dysfunction
rib is prominent, painful, and less springy
Bite mnemoic
during an inhalation dysfunction, treat
the bottom rib with dysfunction first; during an exhalation dysfunction, treat the top
rib with dysfunction first
inhalation dysfunction
Inhalation: one rib stops moving before the others during exhalation (prominent
feeling)
exhalation dysfunction
one rib stops moving before the others during inhalation (sunken
feeling)
lumbar SP are where in relation to TP
same plane
iliac crest is same level as ___
l4
DTR L4 nerve root
L4-5 disc → patellar reflex
DTR S1 nerve root
S1-2 disc → Achilles Reflex
Motor exam L4 nerve root
Ankle Dorsiflexion
motor exam l5 nerve root
big toe dorsiflexion
motor exam s1 nerve root
ankle plantarflexion
Random ROM stuff about lumbar spine
Patient = standing feet 4-6in apart
⦿ Physician = kneeling behind, eyes level with Lumbar spine
⦿ Hands on iliac crest monitoring ASIS ant.
⦿ Flexion = 105º
⦿ Extension = 60º
⦿ SB = 40º
⦿ R = 90º
Hip drop test tests for __
lateral lumbar flexion
describe hip drop test
Pt. Stands with BOTH feet on the ground but one is bent (=displaces weight
to WB leg)
› Look at the amount of hip drop that the bent leg (non-WB) has
› If it drops 25º = normal test = negative test
› If it does not drop 25º = + test on that side
⚫ Indicates restriction to SB on opposite side
⚫ Be sure to check B/L always
⦿ Pt. stands and bends Left leg. You notice that her left iliac crest drops 15º.
Now you instruct her to bend the right leg, and right iliac crest drops 25º.
What is the pt’s restriction?
She has + hip drop on the Left = Restricted to
SB on the RIGHT!!!
SLR test (lasegue test)
Tests for Sciatic Nerve irritation
⦿ Pt. position: Supine
⦿ Dr. Position: extends knee and medially rotates and adducts pt’s hip.
Maintain extension and flex hip
› Continue flexion until pt. feels pain in BACK of symptomatic leg
› Should NOT feel pain until raised to 30-35º
SLR test pain felt at angle less than 30, 30-70 and above 70
At a lesser angle OR in opposite leg = large disc protrusion or herniation
⦿ Between 30-70º = dura stretched
⦿ Above 70º = Sciatic N root irritation
Examining pt. and find they have a hard-end
feel on the L when palpating L1. Does not get
better in Extension, but there is ease of
motion to L2 felt when in flexion. Diagnosis of
the somatic dysfunction?
L1 F RLSL
A 65yo male pt. comes in for evaluation after
a fall on ice. Examination of patient’s Lumbar
spine reveals L2-L5 rotated right. Does not
get better in either flexion or extension.
Diagnosis?
L2-L5 N RR
SL
Louisa Burns, DO
○ Pioneer career osteopathic researcher
○ Experimentally, made spinal lesions and reported the effect on brain, heart, GI, repro, lungs,
kidney → Somatic-Visceral reflexes
J.S. Denslow, DO
○ studies on muscle, muscle reflex and autonomic changes in areas of somatic dysfunction
I.M. Korr, Ph.D
Studies with galvanic skin resistance and the changes associated with autonomic function
○ Nerve function
○ Sympatheticotonia → sympathetic overdrive
○ Took Still’s anatomic foundation and added physiologic function to it
William L. Johnston, DO
○ reliability studies, validity studies, VS reflexes
Influenza epidemic
1918
○ mortality with pneumonia complications less with OMT
● LA County Hospital
DO’s care only → decreased mortality percentage and 6 days less average length of stay then
under MD + DO care
1932
Low back pain patients study
○ OMT + PT + meds had less NSAID use, muscle relaxer and PT then just PT+ meds
1999
OMT pancreatitis
general mobilization of hospital patients
○ decreased length of stay, decreased analgesic, increased patient satisfaction
OMT ankle sprain
general mobilization of hospital patients
○ decreased length of stay, decreased analgesic, increased patient satisfaction
OMT elderly with pneumonia
decreased antibiotic use and decreased length of stay
OMT otitis media in children
for 6 mo-6yo
○ few episodes of AOM, fewer surgical procedures, increased frequency of normal tympanograms
OMT spleen pump
○ OMT splenic pump increased immune cell count
Look at practice ?s
fzddadfva
supination is coupled with
anterior movement of radial head
