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Osteopathic Skills II > OS II Midterm > Flashcards

OS II Midterm Flashcards

1
Q

Diagnosis - Seated Forward Bending Test (SeFBT)

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

A

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

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2
Q

Diagnosis - Backward Bending Test (Sphinx)

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

A

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

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3
Q

Diagnosis - Sacral Mobility During Respiration Test

A

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

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4
Q

Diagnosis - Lumbosacral Spring Test

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

A

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

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5
Q

Diagnosis - 4-point Sacral PROM Evaluation

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

A

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

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6
Q

Diagnosis - Sacral Rock (oblique Axis) passive Evaluation

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

A

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: ???

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7
Q

What is true about oblique axes?

A

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

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8
Q

What is true about a vertical axis?

A

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

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9
Q

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

A

L/R ST

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10
Q

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

A

Pregnancy, delivery that took an extended period time.

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11
Q

L5 sidebends toward the side of the…?

A

Oblique axis (of torsion)

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12
Q

Diagnosis - Trendelenburg Test

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

A

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

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13
Q

Diagnosis - Thomas Test

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

A

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

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14
Q

*Diagnosis - Ober Test

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

A

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

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15
Q

Diagnosis - Standing Flexion Test

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

A

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)

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16
Q

Diagnosis - ASIS Compression Test

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

A

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)

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17
Q

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

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

A

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 #, ????

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18
Q

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

A

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

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19
Q

Treatment - Rib 1 Exhalation SD Met/Art

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

A

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

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20
Q

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

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

A

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

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21
Q

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

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

A

(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

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22
Q

*Treatment - 11-12 Exhalation SD Met/Art

A

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

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23
Q

Treatment - Rib 1 Inhalation SD Met/Art

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

A

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

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24
Q

Treatment - rib 2-6 Inhalation SD Met/Art

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

A

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

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25
Q

Treatment - Rib 7-10 Inhalation SD Met/Art

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

A

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

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26
Q

Treatment - Rib 11-12 Inhalation SD Met/Art

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

A

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

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27
Q

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

A

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.

28
Q

Treatment - Inferior Innominate Shear HVLA

A

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

29
Q

Treatment - Posterior Innominate Rotation BLT (left)

A

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

30
Q

Diagnosis - Sacrum Option 1

  1. ) 4 point Static Evaluation
  2. ) 4 point PROM Evaluation
  3. ) Lumbar spring test

What does each part give you?

A
  1. ) torsion, unilateral, or bilateral and direct base of sacrum is facing based on deep sulcus and posterior/inferior ILA
  2. ) extended (+) or flexed (-)
  3. ) confirmatory
31
Q

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

A
  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)
32
Q

Treatment - Anterior Innominate Rotation BLT

A

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

33
Q

Treatment - Anterior Innominate Rotation HVLA

A

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

34
Q

Treatment - Posterior Innominate Rotation HVLA

A

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

35
Q

Treatment - Superior Innominate Shear HVLA

A

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

36
Q

Treatment - Pubic Somatic Dysfunctions HVLA

A

Pt supine, hips flexed, knees flexed, feet flat on table

Abduction, Adduction, abduction, Adduction - HVLA

37
Q

Treatment - Anterior Innominate Rotation MET

A

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

38
Q

Treatment - Posterior Innominate Rotation MET

A

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

39
Q

Treatment - Superior Innominate Shear MET

A

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

40
Q

Treatment - Inferior Innominate Shear MET

A

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

41
Q

Treatment - Inflare Innominate MET

A

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

42
Q

Treatment - Outflared Innominate MET

A

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

43
Q

Treatment - Pubic Somatic Dysfunctions MET

A

Pt supine, hips flexed 45°, knees flexed 90°

SD alternates having patients adducts and abduct against resistance

Repeat until no new barriers are met

44
Q

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

A

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

45
Q

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

A

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

46
Q

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

A

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

47
Q

*Treatment - Unilaterally Extended Sacrum MET/ART

A

Pt prone, Sphinx position

SD on side of dysfunction

48
Q

Treatment - Unilaterally Flexed Sacrum MET/ART

A

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

49
Q

Treatment - Bilaterally Flexed Sacrum MET/ART

A

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

50
Q

Treatment - Bilaterally Extended Sacrum MET/ART

A

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

51
Q
  • Treatment - Forward Torsion MET/ART

* is there ART for this treatment

A

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

52
Q
  • Treatment - Backward Torsion MET/ART

* no art?

A

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.

53
Q

Treatment - Bilaterally Extended Sacrum HVLA

A

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

54
Q

Treatment - Bilaterally Flexed Sacrum HVLA

A

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

55
Q

Treatment - Backward Torsion HVLA

A

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

56
Q

Treatment - Bilaterally Extended Sacrum Supine BLT

A

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

57
Q

Treatment - Bilaterally Flexed Sacrum Supine BLT

A

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

58
Q

Treatment - Forward Torsion Seated BLT

A

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

59
Q

Treatment - Backward Torsion Seated BLT

A

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

60
Q
  • Treatment - Forward Torsion Supine BLT

* how to do this

A

Flexed Torsion

Pt supine, SD same side as the sacrum is rotated

61
Q
  • Treatment - Backward Torsion Supine BLT

* How the heck do you do this

A

Extended Torsion

Pt supine, SD at same side of sacral base rotation

62
Q

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

A

Iliolumbar ligament

63
Q

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

A

Sacrospinous ligament

64
Q

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?

A

Sacrotuberous ligament

65
Q

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

A

sacroiliac ligament

Osteopathic Skills II (1 decks)

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