OS II Midterm

Question 1

Diagnosis - Seated Forward Bending Test (SeFBT)

What do you do, what’s a positive test, what’s your diagnosis

Answer 1

Pt. Seated facing away from SD

Place thumbs under pts PSIS and have patient bend forward

Positive test: SD thumbs (and PSIS) are higher on one side vs. the other

Diagnosis:
Opposite side is the side of torsional axis

Question 2

Diagnosis - Backward Bending Test (Sphinx)

What do you do, what’s a positive test, what’s a negative test, what’s your diagnosis

Answer 2

Pt laying prone with SD thumbs in sacral sulci

Before any movement look for asymmetry. If no asymmetry don’t do test.

Pt comes up on elbow in sphinx position, watch to see if pt asymmetry corrects with movement

Positive test: there is asymmetry and the backward bending does not resolve the asymmetry pt has an extended sacrum

Negative test: There is asymmetry and the backward bending resolves the asymmetry, pt has a flexed sacrum

Question 3

Diagnosis - Sacral Mobility During Respiration Test

Answer 3

Place hands on pt sacrum, preferably with cephalid facing hand down first to make sure your finger doesn’t go in their bung-hole. Other hand lays on top facing caudally

Positive test: extended sacrum (sacrum doesn’t move into exhalation)

Diagnosis: Inhalation SD

Question 4

Diagnosis - Lumbosacral Spring Test

What do you do, what’s a positive test, what’s your diagnosis

Answer 4

Pt lays prone, SD pushes downward to assess spring of sacrum.

Positive test: sacrum is stiff and does not give to springing force

Diagnosis: sacrum is extended

Question 5

Diagnosis - 4-point Sacral PROM Evaluation

What do you do, what’s a positive test, what’s your diagnosis

Answer 5

Pt prone, SD places thumbs on sacral sulcus and ILA of the same side (unilateral).

Sacral sulcus thumb pushes inferiolaterally toward the greater trochanter

ILA thumb pushes superiolaterally toward the ASIS

Positive Test: look at chart

Diagnosis: 6 possible diagnosis, look at chart

Question 6

Diagnosis - Sacral Rock (oblique Axis) passive Evaluation

What do you do, what’s a positive test, what’s your diagnosis

Answer 6

Pt prone, SD thumb at a sacral sulcus (monitoring)

Other hand’s thenar/hypothenar eminence on the contralateral ILA

Anterior pressure applied on contralateral ILA

Positive Test: restriction of motion about one oblique axis (the monitored suclus doesn’t move posteriorly)

Diagnosis: ???

Question 7

What is true about oblique axes?

Answer 7

On one side of the oblique axes you will have a deep sacral sulcus and on the other side you will have a posterior/Inferior ILA

Question 8

What is true about a vertical axis?

Answer 8

There will be a deep sacral sulcus and posterior/inferior ILA on the same side

Question 9

How would you label a left rotation on a right oblique axis sacral torsion?

Answer 9

L/R ST

Question 10

What is the typical example of a sacrum the is bilaterally flexred?

Answer 10

Pregnancy, delivery that took an extended period time.

Question 11

L5 sidebends toward the side of the…?

Answer 11

Oblique axis (of torsion)

Question 12

Diagnosis - Trendelenburg Test

What do you do, what’s a positive test, what’s your diagnosis

Answer 12

Pt standing, SD behind kneeling so that pt hips are at eye level. Pt lifts right leg and SD watches hips

Positive test: the unsupported hip (right) drops lower than the supported hip (left)

Diagnosis: Positive Left Hip Drop Test

Question 13

Diagnosis - Thomas Test

What do you do, what’s a positive test, what’s your diagnosis

Answer 13

Pt supine, pt brings both knees to chest, pt lowers one leg back to the table

Positive test: inability to fully extend at the hip and lower the leg back to the table

Diagnosis: right or left Psoas tightness/contracture

Question 14

*Diagnosis - Ober Test

What do you do, what’s a positive test, what’s your diagnosis

Answer 14

Pt lies lateral recumbent

SD lifts leg up passively, brings the leg backwards so it’s hovering just posterior to the lower leg and then release

Positive test: leg ratchets down or isn’t able to lower all the way down

Diagnosis: iliac crest outflare

Question 15

Diagnosis - Standing Flexion Test

What do you do, what’s a positive test, what’s your diagnosis

Answer 15

Pt standing facing away from SD, SD at PSIS eye-level, thumbs on PSIS, Pt bends forward

Positive test: one PSIS moves more superiorly

Diagnosis: Right/left SI joint dysfunction (the side of the more superior PSIS is the side of dysfunction)

Question 16

Diagnosis - ASIS Compression Test

What do you do, what’s a positive test, what’s your diagnosis

Answer 16

Pt supine, reset hips, SD places thenar eminences on pt ASIS, SD pushes down into the table alternating from one ASIS to the other

Positive test: unequal resistance from ASIS, one ASIS has a more hard end feel

Diagnosis: Left/right SI joint Dysfunction (the side of the more hard end feel is the side of dysfunction)

Question 17

*Diagnosis - TAT palpatrol screen of Posterior Paraspinal ribs (standing or seated)

What do you do, what’s a positive test, what’s your diagnosis

Answer 17

Pt sitting facing away from SD. Midline for thoracic, more lateral for transverse processes, even more laterally for rib angles. Feel up and down and state what you’re feeling.

Positive Test: tenderness (voiced by pt), asymmetry/protrusions

Diagnosis: Right/left, Rib #, ????

Question 18

Diagnosis - TAT Palpatory Screen of the lateral pump handle ribs and anterior bucket handle ribs

What do you do, what’s a positive test, what’s your diagnosis

Answer 18

Pt supine, SD checks for gross springing and breathing of ribs on right and left laterally, SD palpates individual ribs medially asking the patient to breath feeling for asymmetry

Positive Test: resistance or asymmetrical springing on one side or the other or asymmetry with breathing

Diagnosis: left/right, rib #, inhalation/exhalation somatic dysfunction

Question 19

Treatment - Rib 1 Exhalation SD Met/Art

What do you do, what’s the key rib to treat

Answer 19

Pt supine, SD on opposite of dysfunction

SD adducts arm across body to move scapula out of the way and then places caudal hand under rib 1

Pt dysfunction side arm placed on forehead with palm facing up

SD resists pt motion as they try to lift off their head

Increase caudad lateral traction

Repeat MET 3 - 5

Question 20

*Treatment - Rib 2-6 Exhalation SD Met/Art

What do you do, what’s the key rib to treat

Answer 20

Pt supine w/ arm completely back and above head on dysfunctional side of rib

SD on opposite side

Caudad hand slips under back (arm across chest to load) w/ hand on superior part of top dysfunctional rib

Cephalad hand rests on pts elbow

Caudad applies anterior and lateral traction while pt pushes against SD cephalad hand as SD resists

Increase lateral traction (caudad hand)

MET 3 - 5x

Question 21

*Treatment - Rib 7-10 Exhalation SD Met/Art

What do you do, what’s the key rib to treat

Answer 21

(6-8)

Pt supine, cross pt arm over body to load cephalad hand under dysfunctional rib

Keep pt. Arm crossed over the body placing caudal hand on elbow

SD on side of dysfunction

Apply lateral traction with cephalad hand on superior part of dysfunctional rib while pt pushes elbow to the ceiling against SD caudal hand while SD resists

Increase cephalad traction

repeat MET 3 - 5

Key rib is superior part of top dysfunctional rib

Question 22

*Treatment - 11-12 Exhalation SD Met/Art

Answer 22

Pt prone, leg of dysfunction slightly abducted

SD stands on opposite side of dysfunction

Cephalad hand on dysfunctional ribs
Caudad hand grasps iliac crest

Cephalad hand pushes into the table and slightly cephaladly while pt raises dysfunctional side hip towards dysfunctional side shoulder while SD resists

Increase caudad lateral traction

repeat MET 3 - 5

Question 23

Treatment - Rib 1 Inhalation SD Met/Art

What do you do, what’s the key rib to treat

Answer 23

Pt supine, SD at head of bed

Ipsilateral thumb placed on in the supraclavicular fossa to monitor first rib

Head flexed, side bent towards dysfunction, rotated away from dysfunction

Have patient breath normally, resist inhalation (superior movement) and push with exhalation (inferior movement)

Repeat 5 - 7 times

Question 24

Treatment - rib 2-6 Inhalation SD Met/Art

What do you do, what’s the key rib to treat

Answer 24

Pt supine, SD knee under dysfunctional ribs (pt will be sat up slightly to accommodate this)

The webbing between the thumb and index finger is placed over the intercostal space superior to the dysfunctional rib

During inhalation resist movement
During exhalation pushed down and further movement

Repeat 5 - 7 times

Question 25

Treatment - Rib 7-10 Inhalation SD Met/Art What do you do, what’s the key rib to treat

Answer 25

Pt supine, dysfunctional side shoulder completely abducted 180° from body Thumb and index finger on top of surface of dysfunctional rib Sidebend pt towards the dysfunctional rib During Inhalation resist motion During exhalation exaggerate/push further the motion Repeat 5 - 7 times

Question 26

Treatment - Rib 11-12 Inhalation SD Met/Art What do you do, what’s the key rib to treat

Answer 26

Pt prone, abduct legs slightly towards the side of dysfunction Caudal hand on ASIS Cephalid hand hypothenar eminence utilizes downwards force on ribs 11 & 12 Apply resistive force during inhalation Push further during exhalation Repeat 5 - 7 times

Question 27

Diagnosis - Landmark identification and comparison of innominate & pubic somatic dysfunction

Answer 27

Do standing flexion test first to find which side the dysfunction is on Next, have pt lay supine and check ASIS, PSIS, Medial malleoli, pubic symphysis. Compare anatomy points w/ relation to the side of dysfunction.

Question 28

Treatment - Inferior Innominate Shear HVLA

Answer 28

Pt lateral recumbent with dysfunctional side up, SD behind pt hook thenar/hypothenar under ASIS and PSIS and have pt take three breaths At the end of the third breath induce HVLA cephaldly

Question 29

Treatment - Posterior Innominate Rotation BLT (left)

Answer 29

Pt sits in front of SD with both legs extended Left leg gets pushed posteriorly, right leg gets pulled anteriorly Pt turns to the same side of the dysfunction until movement is felt in the somatic dysfunction leg (so in this case left) Pt takes a deep breath until ease is determined by SD and then SD tells pt to hold breath until air hunger

Question 30

Diagnosis - Sacrum Option 1 1. ) 4 point Static Evaluation 2. ) 4 point PROM Evaluation 3. ) Lumbar spring test What does each part give you?

Answer 30

1. ) torsion, unilateral, or bilateral and direct base of sacrum is facing based on deep sulcus and posterior/inferior ILA 3. ) extended (+) or flexed (-) 2. ) confirmatory

Question 31

Diagnosis - Sacrum Option 2 1. ) 4 Point Static Evaluation 2. ) Backward Bend (Sphinx) Test 3. ) Sacral Rock (oblique axis) 4. ) Respiratory Motion testing What information do these test provide

Answer 31

1. ) unilateral, bilateral, or torsion, and direction sacral base is facing 2. ) flexion (-) or extension (+) 3. ) tells you the oblique axis 4. )flexion (inhalation) or extension (exhalation)

Question 32

Treatment - Anterior Innominate Rotation BLT

Answer 32

Pt seated, SD seated in front of pt Legs extended in front of SD, SD grasps legs above ankle SD pulls on dysunctional leg and pushes/compresses opposite leg Pt turns to contralateral side from dysfunction until the dysfunctional leg begins to move Pt takes deep breath and holds Wait for air hunger, release

Question 33

Treatment - Anterior Innominate Rotation HVLA

Answer 33

Pt lateral recumbent with dysfunctional side up SD faces the pt Cephalid hand looped through pt up-facing arm and monitors lumbrosacral joint Caudad hand flexes pt hip and knees until joint separates

Question 34

Treatment - Posterior Innominate Rotation HVLA

Answer 34

Pt lateral recumbent w/ dysfunctional side up facing SD Cephalid hand loops under pt arm and monitors lumbrosacral joint Caudad hand flex pts hips and knees until movement at the lumbrosacral joint Upper leg bent and foot of that leg placed behind popliteal fossa Caudal forearm placed on PSIS and ILIAC CREST Cephalid hand pushes shoulder posterior via the antecubital fossa Opposing forces applied until tension and then HVLA

Question 35

Treatment - Superior Innominate Shear HVLA

Answer 35

Pt supine with feet off end of table SD grabs affected side leg SD internally rotates, abducts leg, induces axial traction Instruct pt to breath for 2 - 3 cycles, on exhalation after 3 cycle induce HVLA

Question 36

Treatment - Pubic Somatic Dysfunctions HVLA

Answer 36

Pt supine, hips flexed, knees flexed, feet flat on table Abduction, Adduction, abduction, Adduction - HVLA

Question 37

Treatment - Anterior Innominate Rotation MET

Answer 37

Pt prone, dysfunctional innominate off table SD on side of dysfunction (leg off table) One hand on Sacrum/pelvis for stability Other hand supports knee of leg off table and places dysfunctional innominate foot on SD thigh Pts foot passively flexed until barrier is reached Pt applies force against SD leg

Question 38

Treatment - Posterior Innominate Rotation MET

Answer 38

Pt prone Cephalid hand on pts PSIS of dysfunctional leg Caudad hand extends dysfunctional hip until barrier reached Pt applies downward force MET performed 3 - 5

Question 39

Treatment - Superior Innominate Shear MET

Answer 39

Pt supine with feet off table SD grabs dysfunctional side leg, internally rotates and abducts leg gapping the SI joint SD leans back inducing traction Pt instructed to retract leg against SD force 3-5x Modification: SD maintain force on Inhalation and increase force on exhalation

Question 40

Treatment - Inferior Innominate Shear MET

Answer 40

Pt supine, feet off table SD grasps dysfunctional leg, internally rotates, abducts to gap SI joint Pts foot placed on SD thigh, SD loads dysfunctional leg by compressing pt applies caudal force against SD resistance 3-5x

Question 41

Treatment - Inflare Innominate MET

Answer 41

Pt supine, dysfunctional knee flexed, dysfunctional hip flexed, foot draped over and placed on lateral side of opposite knee Cephalad hand on pt’s ASIS Caudal hand on pt’s flex knee (dysfunctional) External rotate pt hip until resistance met Pt pushed back towards midline, SD resists Repeat 3-5 times

Question 42

Treatment - Outflared Innominate MET

Answer 42

Pt supine, dysfunctional hip flexed, dysfunctional knee flexed, foot draped over and placed on lateral side of opposite knee SD stands opposite dysfunction Cephalad hand on opposite ASIS Caudal hand internally rotates hip until restrictive barrier met Pt attempts to externally rotate hip against resistance Repeat 3-5x

Question 43

Treatment - Pubic Somatic Dysfunctions MET

Answer 43

Pt supine, hips flexed 45°, knees flexed 90° SD alternates having patients adducts and abduct against resistance Repeat until no new barriers are met

Question 44

Diagnosis - Supine patient: TAT palpatory screen of the lateral bucket handle and anterior pump handle ribs

Answer 44

Pt supine SD palpapates anterior ribs using ulnar side of hand for patient consideration (or fingers for male) Feel for protrusions, tissue texture abnormalities, and ask for tenderness SD moves to side starting rib 3 moving downwards. Introduce lateral springing force over numerous ribs from side to side to feel for protrusions, tissue texture abnormalities, restrictions, and ask for tenderness

Question 45

Diagnosis - Demonstrate & desrcribe screening AROM of ribs 3-5 and 6-10 and diagnose the most significant rib somatic dysfunction

Answer 45

Pt supine, SD at the head of the bed Move anteriorly from rib 3 to rib 6 palpating and checking with respiration. State “checking pump handle for 3 - 6” Finally, move laterally checking ribs 3 - 6 against respiration and springing. State “checking for bucket handle motion 3-6” Lastly, check ribs 7-10 using butterfly technique w/ thumbs at xiphoid process checking against respiration. State “checking for bucket handle motion 7-10” Diagnosis inhalation or exhalation remembering BITE pneumonic

Question 46

Diagnosis - Demonstrate & desrcribe screening AROM of ribs 1 & 2 and 11 & 12 and diagnose the most significant rib somatic dysfunction

Answer 46

Rib 1-2: Pt supine, SD at head of bed Thumb in supraclavicular fossa to check for bucket handle motion. Place index and middle finger surrounding the clavicle with middle finger palpating rib 1 anteriorly to check for pump handle motion. Check against respiration. Palpate rib 2 and check against respiration and state, “checking for pump handle motion of rib 2” Pt goes prone, SD at pt side Find rib 11 & 12 and wrap hands around rib with thumbs medial pointing cephaladly. State, “checking caliper motion of ribs 11 & 12” check against respiration

Question 47

*Treatment - Unilaterally Extended Sacrum MET/ART

Answer 47

Pt prone, Sphinx position SD on side of dysfunction

Question 48

Treatment - Unilaterally Flexed Sacrum MET/ART

Answer 48

Pt prone, SD on side of dysfunction Cephalad hand palpates sacral sulcus Caudad hand abducts and internally rotates hip until movement felt at sulcus Place both hands on dysfunction side ILA MET: Resist during exhalation, push during inhalation. Continue until no barriers left ART: springing motion until improved

Question 49

Treatment - Bilaterally Flexed Sacrum MET/ART

Answer 49

Pt prone, SD at pt side Abduct and internally rotate both legs Caudad hand thenar/hypothenar eminence placed on apex of sacrum. Apply a Anterior/Superior force MET: resist exhalation, push inhalation. Repeat 3-5 breathing cycles ART: apply a springing force until motion improves

Question 50

Treatment - Bilaterally Extended Sacrum MET/ART

Answer 50

Pt prone, SD at side of patient Abduct and internally rotate both legs Place thenar/hypothenar eminence on sacral base and apply a superior/anterior force MET: resist inhalation, push exhalation. Repeat for 3-5 respiratory cycles ART: apply springing motion until movement improves

Question 51

* Treatment - Forward Torsion MET/ART | * is there ART for this treatment

Answer 51

Flexed Torsion Pt prone, then modified sims with axis pointing down SD sitting in front of pt facing caudal direction SD monitors L5-S1 and flexes hips and knees until motion felt at space Rest pts legs on SD knees MET: Pt attempts to lift feet into the air against SD resistance Feet are pushed closer to floor to engage next barrier. Repeat 3-5 times

Question 52

* Treatment - Backward Torsion MET/ART | * no art?

Answer 52

Extended Torsion Pt. Lateral recumbent position with axis side down Pt turns so they are looking up at the ceiling and top half is in a supine position Pt knees and hip flexed to 90° Superior leg brought forward off the table until motion felt at the L5-S1 joint MET: Pt pushes upwards against SD resistance Next barrier engaged by pushing further towards the floor. Repeat 3-5.

Question 53

Treatment - Bilaterally Extended Sacrum HVLA

Answer 53

Pt prone, SD at side of table Monitor SI (L5-S1), abduct and EXTERnally rotate both legs until motion felt Thenar/hypothenar eminence on sacral base with fingers pointing CAUDALLY Apply anterior/inferior force on sacral base. RESIST inhalation, PUSH exhalation Hold MET for 3 rounds and then at the end of exhalation on the third breath induce HVLA

Question 54

Treatment - Bilaterally Flexed Sacrum HVLA

Answer 54

Pt prone, SD at side of table Monitor SI (L5-S1), abduct and INTERnally rotate both legs until motion felt Thenar/hypothenar eminence on sacral base with fingers pointing CEPHALADLY Apply anterior/SUPERIOR force on sacral base. PUSH inhalation, RESIST exhalation Hold MET for 3 rounds and then at the end of exhalation on the third breath induce HVLA

Question 55

Treatment - Backward Torsion HVLA

Answer 55

Extended Torsion Pt supine, SD on side of deep sulcus Sidebend pt away from deep sulcus (C-shape) Pt puts both hands behind neck Caudad hand thenar eminence on opposite ASIS Cephalad hand loops behind opposite arm that is creating a loop due to hand behind neck. Pt does a side-ab crunch toward SD and SD places dorsum (back of) hand on pt manubrium SD pulls opposite shoulder toward self to fully engage barrier Pt asked to take a deep breath and during exhalation HVLA of the Shoulder inwards and ASIS into the table

Question 56

Treatment - Bilaterally Extended Sacrum Supine BLT

Answer 56

Pt supine, SD at side of table Caudad hand goes under and pushes anteriorly at sacral apex Pt asked to take a deep breath, find ligamentous balance, ask pt to take another breath and hold until air hunge

Question 57

Treatment - Bilaterally Flexed Sacrum Supine BLT

Answer 57

Pt supine, SD at side of table Push anteriorly on sacral base Pt takes a deep breath, find balanced ligamentous tension, pt takes another breath and holds at that point until air hunger

Question 58

Treatment - Forward Torsion Seated BLT

Answer 58

Flexed Torsion Pt seated, SD seated behind Deep sulcus monitored while extended pt passively using pt shoulder until sulcus is no longer as deep (balanced with the other side) Next, rotate pt towards their sacral rotation Sidebend away from the deep sulcus Pt takes a deep breath, find balanced ligamentous tension, pt takes another breath and holds until air hunger

Question 59

Treatment - Backward Torsion Seated BLT

Answer 59

Extended Torsion Pt seated, SD seated at the side opposite the side of the oblique axis Pt. Crosses arms and holds Pt flexed at the head until the extended sacral base moves back in line with the other side of the sacral base Rotate pt in direction of sacral rotation Side bend pt away from the deep sulcus Have pt take in deep breath to find balanced ligamentous tension, pt takes another breath in and hold at that point. Wait for air hunger

Question 60

* Treatment - Forward Torsion Supine BLT | * how to do this

Answer 60

Flexed Torsion Pt supine, SD same side as the sacrum is rotated

Question 61

* Treatment - Backward Torsion Supine BLT | * How the heck do you do this

Answer 61

Extended Torsion Pt supine, SD at same side of sacral base rotation

Question 62

What ligament connects the ilia to the 5th lumbar vertebrae?

Answer 62

Iliolumbar ligament

Question 63

What ligament connects the sacrum to the spine of the ischium?

Answer 63

Sacrospinous ligament

Question 64

Which ligament runs from lower sacral tubercles to ischial tuberosity and stabilizes to prevent posterior-superior rotation of the sacral apex around a transverse axis?

Answer 64

Sacrotuberous ligament

Question 65

What ligament covers much of the sacroiliac joint both anterior and posterior portions?

Answer 65

sacroiliac ligament