OS Test 2 Flashcards
What is the point of the foot arch?
Shock absorption, Allows foot to adapt to surface and weight changes
What is in the Medial Longitudinal arch?
calcaneus, talus, navicular, 3 cuneiforms and medial 3 Metatarsals
What is in the Lateral Longitudinal arch?
Calcaneus, cuboid, lateral 2 metatarsals
Transverse arch contents
navicular, cuboid, 3 cuneiforms, proximal metatarsals
Contents of Tarsal Tunnel
Tibialis posterior m., flexor digitorum longus, flexor hallucis longus
Tibialis posterior actions
INVERSION and plantar flexion
Flexor digitorum longus actions
Flexes lateral four digits, plantar flexion at ankle joint
Flex hallucis longus actions
Flexes great toe, plantar flex the foot at ankle joint
Primary stabilizer of medial ankle is___
what kind of sprain is associated?
Deltoid ligament, eversion ankle sprain
Ligaments of lateral ankle and which tears first
Posterior talofibular ligament
Anterior talofibular ligament (first)
Calcaneofibular ligament
Ankle ROM for Dorsiflexion, plantarflexion, inversion(supination), eversion
D: 15-20
P: 50-65
Inversion: 35
Eversion:20
Pronation is what movements
dorsiflex, ABduction, calcaneal eversion
Supination is what movements
Plantar flex, ADduction, calcaneal inversion
Dysfunction is where there is ease/restriction of motion?
EASE, where it likes to live
Lateral malleolus dysfunction
first translate lateral malleolus ANT and POST.
If freedom of motion to anterior glide: anterior lateral malleolus dysfunction (restriction to posterior)
If freedom of motion to posterior glide: posterior lateral malleolus (restriction to anterior glide)
Where do you document dysfucntion in SOAP note
OBJECTIVE
Navicular dysfunction
Stabilize TALUS and grasp navicular with thumb and first finger-force into dorsal and ventral glide
Plantar dysfunctions most common
Navicular dysfucntion are associated with tight plantar fascia
cuboid dysfunction
Stabilize CALCANEOUS and grasp cuboid with thumb and first finger-force into dorsal and ventral glide
Plantar dysfunctions most common
Cuboid dysfucntion are associated with posterior fibular head
Cuneiform dysfunction:
stabilize navicular and force each bone into dorsal/ventral
Checking Talus
Motion occurs b/t talus and distal tib/fib
stabilize distal tib/fib and check talus for dorsiflexion and plantar flexion dysfunction
Checking Calcneus
Motion occurs b/t talus and Calcaneus
Place ankle at 90 degrees to prevent laxity
test inversion and eversion somatic dysfucntion
Knee ROM
Flexion, extension, internal and external rotation
Q angle
Flexion: 140-150
Extension: 0-5
Internal rotation: 10
External rotation: 10
Checking Internal/external rotation of tibia on femur
Block linkage proximally
• Thumbs on tibial tuberosity, knee and hip bent to 90
• Rotate internally and externally, noting restriction
Checking abduction/aduction of tibia on femur
Create valgus/varus stress on knee
Valgus- push knee towards midline (ADduction)
Varus: push knee away from midline (ABduction)
Tibia on Femur- A/P slide
Same as anterior drawer test with less force
Proximal fibular evaluation
grab fibular head and translate a/p, assess gliding motion
NB: common fibular nerve wraps around fibular head and is subject to injury with fibular head fracture
HIP ROM Flexion-knee extended and flexed extension internal rotation external rotation AB/ADduct
flexion: 90-extended/ 120-135 (knee flexed)
extension:15-30
internal rotation: 30-40
external rotation: 40-60
ABduct-45-50
ADduct=20-30
Hip compartments: Central
ALL
Articular surface, ligamentum teres, labrum
Peripheral Hip compartment
Femoral neck and synovial lining
Lateral hip compartment
Gluteus medius/minumus, IT band, trochanteric bursa
GIT
Anterior hip compartment
Iliopsoas insertion, iliopsoas bursa
Hip testing- always do
BLOCK linkage
For hip flexion testing, pt is ___
for hip extension testing, pt is ___
For int/external rotation, pt is ___
AD/AB- patient supine
flexion-supine
extension- prone
int/ext-either knees flexed to 90
AB/AD patient is supine
Lymph facts
Integrates all body fluids, important for homeostasis, transports fats from digestive system to blood
Lymph facts (immune)
conduit to immune system, passive, altered by OMT
Lymph development
starts at 5 weeks, significant at 20 weeks,
mature until puberty and is stable in adult
Spleen location and fxn
b/t ribs 9-11 on left side, not palpable
destorys RBCs, makes IGs, clears ags, microorganisms and some bacteria
Thymus location and fxn
Superior mediastinum, ant to vessels
largest at age 2 and involutes after puberty
T cell processing, little fxn in adults
Tonsils (3)
which are you looking at with ahhhhhhhhhhhhh
Superior to inferior- Pharyngeal (adenois), palatine, and lingual
ahhh- palatine
appendix is where
medial surface of cecum
Visceral tissues within GI
Peyer’s patches in distal ilium
Lacteal are lymph capillaries of villi in SI
liver clears bacteria and creates 1/2 of body’s lymph
pulmonary visceral tissues fxn
filters toxins from lungs
Lymph nodes purpose and types
Filtration, superficial and deep
Superficial lymph and where it drains
runs with superficial veins
drains to
Cervical-head, supraclavicular and UE to jugular nodes
Axillary-infraclavicular to umbilicus to axillary to subclavian
inguinal- caudal to umbilicus to inguinal nodes to lumbar
deep lymph and where it drains
run below fascia and muscle and run with deep veins
drain to collecting ducts
where doesn’t lymph go
CBS, EE
CNS, Bone marrow, selection portion of peripheral
epidermis and endomysium
Lymphatic drainage
unidirection flow, one way valves, larger vessel under sympathetic control-stress causes tissue congestion
Lymph drainage Right
Drains r side of head, neck and R UE and chest
lymph drainage left
everything else drains here, left side of head and neck, L UE, L thorax, R and L LE, viscera of thorax
Lymph mechanism
interstitial fluid pressure is normally -6.3 mmhg, if get to 0 then vessels collapse
interstitial fluid pressure increases with ___
HTN, increased capillary permeability (starvation) , increased interstitial protein( toxins), decreased plasma osmotic pressure (hepatic cirrhosis)
thoracic duct location
against vertebral column b/t aorta and azygous vein
moves left of midline at t4 to go to L brachiocephalic and subclavian vein
Cisterna chyli-what is it and location
dilation of thoracic duct
L1-2 posterior to the R crura of the diaphgram
components of lymphs
proteins, salts, fats, lymphocytes, clotting factors, large particles like viruses and bacteria
edema associated factors
CHF, imcompetent heart valves, venous obstruction, gravitation effects
edema associated factors with fluid not getting out
decreased osmotic pressure gradients due to starvation, cirrhosis of liver, abnormal protein metabolism
could also be due to tramua, post-op scarring or mechanical blockage
effects of edema
tissue congestion, fluid stasis can alter pH, fibrosis/contractures, ineffective delivery of nutrients, drugs and hormones
reasons not to do OMT for lymph
Metastatic cancer, Osseous fracture, Acute bacterial infection w/ tem>102 and not on antibiotics • Acute hepatitis • Mono
• Circulatory disorders (venous obstruction,
hemorrhage, embolism,
• Coagulopathies (on anticoagulants – Warfarin)
• No urine production (dialysis)
• Pt can’t tolerate tx (CHF – can’t be supine)
*Virchow’s node,
located in the supraclavicular region on the left side, is associated with any intra-abdominal or thoracic carcinoma/cancer.
shoulder joint
3 bones, 3 true joints, 2 functional joints, 2 accessory joints
bones: clavicle, scapula, humerus
3 true joints: GAS- glenohumeral, acromioclavicular, sternoclaviuclar
2 functional joints: Suprahumeral, scapulothoracic
2 accessory joints: costosternal, costovertebral
shoulder important landmarks
spine scapula-t3
inferior border of scapula-t7
rotator cuff muscles
SITS- Supraspinatus, infraspinatus, teres minor, subscapularis
Early shoulder abduction is done by what joints
Glenohumeral and suprahumeral
mid-late shoulder abduction is done by what joints
scapulothoracic, sternoclavicular, acromioclavicular
AC joints angles
60 degrees coronal abduction and 60 degrees horizontal adduction
IR at GH is same as IR at AC joint
restrict to IR is a ER rotation dysfunction of AC joint ???????
SC joint somatic dysfunction more common in __
extension
Scapulothoracic joint elevation is what m.
upper traps and levator
depression of scapulothoracic joint
lower traps and rhomboids
abduction of scapulothoracic joint is
protraction, serratus ant,moves away from spine
adduction- retracton
middle traps and rhomboids, move closer to spine
rotation of ST joint
upward is forward tilt- inferior angle protrudes and is done by serratus and upper traps
downward is backward tilt, inferior angle moves anterior and is done by levator, rhomboids and lat
lift off test evaluates
internal rotation
evaluate scapular retraction by
resisting position of attention
evaluate scapular protraction
by having pt do a wall push up
muscle strength testing
5= complete ROM and full resistance 4- complete ROM and some resistance 3- complete rom against gravity 2- complete ROM, no gravity, 1- muscle contraction but no joint movement 0- no muscle contraction
