OS3 Exam 1 Flashcards
What are the 5 characteristics of CRI?
What is the typical rate of CRI?
Rate, rhythm, amplitude, direction, strength
10-14 times per minute
What are the 5 components of the primary resp mechanism
CNS, CSF, dural membranes, cranial bones, sacrum
Explain the motions assoc w/ cranial F (include sacrum) (include dimensional changes)
SBS- sup
Sphenoid and vomer- ant/inf
Occiput and ethmoid- post/inf
Parietal bone- ext rotate
Interpalatine suture- inf
Sacrum (counternutation)- sacral base moves post
Ant/post dimension dec; transverse dimension inc
Explain motions assoc w/ cranial E (include sacrum) (include dimensions)
SBS- inf Sphenoid and vomer- post/sup Occiput and ethmoid- ant/sup Palatine- int rotate Interpalatine suture- sup Sacrum (nutation)- sacral base moves ant A/P dimension inc; transverse dimension dec
Explain balanced membranous tension
Indirect treatment where you find the midpoint of movement of SBS in vault hold and hold at the midpoint until you reach a still point and continue to hold until CRI returns and is more symmetrical
Explain SBS Lateral Strain
Named for which sphenoid is more ant/sup- whichever hand rotates over the other
Sphenoid and occiput rotate in same direction on a vertical axis
Ex. R SBS lateral strain- right sbs shear where right sphenoid and occiput rotate left on vertical axis
Explain SBS vertical strain
Sphenoid and occiput F and E together but oppositely
Sup strain- sphenoid F and occiput E; thumbs point away
Inf strain- sphenoid E and occiput F; thumbs point toward
Explain SBS torsion
Named for side w/ more sup sphenoid (thumb points to you)
SBS rotates around an AP axis in the coronal plane; sphenoid and occiput rotate in opposite directions
R SBS torsion- R sphenoid rotates L, R occiput rotates R, R thumb points at you
What are the assoc changes w/ SBS torsion
Temporal and parietal- ext rotate on side of torsion
Orbit- smaller on side of torsion
Mandible- shifts to side of torsion
Falx cerebri- ant portion moves w/ sphenoid; post portion moves w/ occiput
Tentorium cerebelli- SB direction occiput R
Spinal dura- inf on side of torsion
Explain SBS SB and R
SBS R in AP axis and SB in vertical axis; sphenoid and occiput R same direciton but SB in opposite directions; named for side of convexity (hands move down and out)
R SBS SB/R- R sphenoid RR and SBL; R occiput RR and SBR; right hand moves down and out and left hand moves up and in
Explain assoc changes w/ SBS SB R
Temporal and Parietal- ext rotate on side of convexity
Orbit- moves ant on side of convexity
Mandible- shifts toward side of convexity
Falx cerebri- SB following direction of SBS SB
Tentorium cerebelli- follows occiput
Spinal dura- infection on side of convexity
Explain moves of parietal bone during cranial F and E; what axis and plane of motion; what are symptoms assoc w/ parietal bone SD; how do you treat
Cranial F- ext rotate Cranial E- int rotate AP axis in coronal plane Symptoms- HA and altered threshold for seizures Treat- parietal lift
Explain frontal bone motions w/ cranial F and E; what axis and plane of motion; what are symptoms assoc w/ frontal SD; how do you treat
Cranial F- ext rotate Cranial E- int rotate AP axis in coronal plane Symptoms- HA, visual deficits, smell deficits (assoc w/ ethmoid) Treat- frontal lift
Explain motion of temporal bone during cranial F and E; what are symptoms assoc w/ SD; how do you treat
Cranial F- ext rotate (low pitched tinnitus)
Cranial E- int rotate (high pitched tinnitus)
Symptoms- migraine, bells palsy, tinnitus, OM
Treat- temporal rocking
What is V spread used for
Release of any suture
Explain CV4 treatment
Volleyball hold just medial to occipitomastoid suture
Encourage E and resist F
Explain eval of TMJ
Symmetry (break face into 3rds)
Malocclusions (class 1 nml, class 2 overbite (B>A), class 3 underbite)
Palpate and muscle testing
Open and close mouth (C vs S shaped)
Explain TMJ ME for C and S shaped SD
C shaped- thenar eminence on body of mandible on side of SD, have pt slightly depress mouth, press toward oppo side and have pt resist, repeat
S shaped- warm cloth on TMJ 15 min, open/close, side/side, protract/retract against R for 20 sec, sets of 10, twice a day
explain TMJ MFR (u/l and b/l)
U/l- turn pt head so SD is up, apply caudad force on angle of mandible w/ thenar eminence and hold till tissue creep
B/l- apply caudad force on both angles of mandible w/ thenar eminences and hold until tissue creep
Explain counterstrain for masseter and TMJ
Masseter- monitor tender point inf to zygoma in belly of masseter; push on other side of jaw towards you
TMJ- tender point is behind angle of ramus; turn head so SD side is up
Explain how to reduce ant disc for TMJ
Digits 4 and 5 on angle of ramus, digits 2 and 3 on body of mandible, and other hand thenar eminence on contralat body of mandible
Lift digit 4/5 ant -> lift digit 2/3 sup -> apply lateral force w/ thenar eminene
What are the 5 models of OMM
Biomechanical Neuro Resp/circ Metabolic/nrg/immune Behavioral
What are some treatments that deal w/ sympathetics
Paraspinal inhibition (t10-l2)-hold for 90 seconds Collateral ganglia inhibition (xiphoid to belly button- celiac, SMG, IMG)- press during exhale and resist inhale Rib raising (supine or seated- normalize symp tone)
What are treatments involved in parasympathetics
Suboccipital release
OA/AA ME (normalize parasymp tone- inc tone)
Sacral rocking (inc tone)
Sacral inhibition (dec tone)
List the ANT chapman points on the right
R 2 ICS- esophagus R 5 ICS- liver R 6 ICS- gb R 7 ICS- pancreas R 8-10 ICS- small bowel R tip of rib 12- appendix
List ANT chapman points on the sternum, left side, and legs
Sternum- pylorus
L 5 ICS- stomach acidity
L 6 ICS-stomach
L 7 ICS- spleen
R leg- sup is cecum and inf is transverse colon
L leg- inf is transverse colon ad sup is sigmoid
List the post chapman points
R T2- esophagus R T5-6- liver and GB L T5-6- stomach acidity and GB R T7-8- pancreas L T7-8- spleen R T8/9, T9/10, T11/12- small bowel R rib 10 pylorus
Explain soft tissue for GI:
Lower thoracid under shoulder lat recumbent
Prone P counterpressure
Lower thoracic: pt lat recumbent w/ side to be treated up; doc facing pt; reach under shoulders and grab just lat to SP on paravert muscles and apply an anterolateral force and hold
Prone P w/ counterP- pt prone w/ doc on side of table; thenar eminence of caudad hand on oppo side paravert m; hypothenar eminence of ceph hand on same side paravert m; move hands in direction they are facing
Explain lymphatic treatments for GI pt
Thoracic inlet Dome diaphragm Ischiofossal release (pelvic diaphragm) Rib raising Pedal pump
Explain mesenteric release and where doc stands
Small intestine (doc on R side) Ascending colon (doc on L side) Descending colon (doc on R side) Cecal lift (doc on L side pulls toward belly button from ASIS)
With regards to compression neuropathy explain the following:
- compression test
- spurlings test
- neck distraction
Compression- apply caudad force on pt head (positive to reproduce symptoms)
Spurlings- neutral, extend, SB towards (positive if reproduce symp)
Neck distraction- positive if it relieves pain/symptoms
What direction does a herniated disc typically occur in?
Postero-laterally
What are the boundaries of the thoracic outlet; what are the 3 areas w/in?
Boundaries- 1st rib, T1, and manubrium
Scalene triangle, costoclavicular space, and pec minor
What are some special tests for thoracic outlet syndrome and what do they indicate if positive
East test (subclavian a compression)
Adson- look at rib; look away scalene
Halstead/military- compressed between 1st rib and clavicle
Wrights hyperABduct- compressed by pec minor
What is an example of ME used to treat thoracic outlet syndrome and how do you perform
Rib 1 ME (pump or bucket)
Pump- flex pt head; resist inhale and force exhale
Bucket- flex head and SB toward SD; resist inhale and force exhale
What nerve is compressed during cubital tunnel syndrome and what are 2 tests to look for it?
Ulnar N
Tinels sign at elbow
Froments sign (thumb flexes- tests strength ofadductor pollicis)
What are 2 different treatments for cubital tunnel syndrome
Radial Head ME (post/pronate, ant/supinate)- pronate or supinate against resistance
Proximal Ulnar ME- varus/valgus force
What nerve is compressed in carpal tunnel syndrome and where is it typically compressed? What are 2 tests for it?
Median nerve entrapped under flexor retinaculum
Tinels wrist test
Phalens test
What are two treatments used for carpal tunnel syndrome
MFR at flexor retinaculum
Articulatory squeeze
What are 3 treatments used for common fibular n compression
Post fibular head ME/HVLA- dorsiflex, evert, and ext rotate; MCP on post fibular head; bring into hyperflexion and pull ant
Gastrocnemius ME
Biceps femoris ME
What nerve is compressed in anterior tarsal tunnel syndrome
Deep fibular n
What are 2 treatments for anterior tarsal tunnel syndrome
MFR of extensor retinaculum Hiss whip (cuboid-navicular)
What nerve is compressed in tarsal tunnel syndrome
Posterior tibial n
What are 2 treatments for tarsal tunnel syndrome
MFR for flexor retinaculum ( evert calc and dorsiflex)
evert ankle SD- invert and pull HVLA
What nerve is compressed in meralgia paresthetica and by what?
Lateral fem cutaneous n compressed under the inguinal ligament
What are treatments for meralgia paresthetica
Ant innominante- ME (supine or prone)
Hip F ME or MFR
Where are tender points typically located?
Do they radiate?
In the belly of the muscle or near the tendinous insertion
Do not radiate
Explain what type of treatment counterstrain is and the general process (8 steps)
Counterstrain is a passive indirect treatment for tender points
Steps: ID SD, find TP, establish pain scale, move into direction of ease, reduce tenderness 70%, hold for 90 sec, SLOWLY return to neutral, re-eval
What are some general rules of counterstrain treatments
Ant TP- F and SB toward
Post TP- E and SB away
Hold for 90 seconds (120 for ribs)
Must reduce by at least 70%
What are the anterior TP for cervical spine
What are the post TP for cervical spine
Ant- Lateral masses (F SARA)
Post- SP or just lateral to the inbetween TP (E SARA)
What are the ant TP for thoracic spine
Ant- AT1-6- at sternocostal joints just lat to sternal border
Ant- AT7-12- just lateral to midline in rectus abdominus m
Ant- AL7 and 8- 1 and 2 inches from xiphoid on costal cartilage
F SARA
What are the post TP for thoracic spine
Post- inbetween SP and TP
E SARA
What are the ant TP for ribs
Ant- Rib 1- just inf to medial aspect of clavicle
Ant- Rib 2- 1.5 inch lat to sternum
Ant- Rib 3-6- mid axillary line
F STRT
What are the post TP for ribs
Post- rib angles along the medial border of the scapula
F SARA
What are the ant TP for lumbar spine
Ant- AL1- medial to ASIS
Ant- AL2-4- medial, lateral, inf to AIIS
Ant- AL5- just lat to pubic symphysis and tubercle
What are the post Tp for lumbar spine
Post- L1-5- SP Post- L1-3- TP Post- UPL5- superior PSIS Post- LPL5- inferior PSIS Post- lat PL3- between PSIS and TFL Post- lat PL4- TFL
What bones make up the pterion (3)
What fontanelle was it
Frontal
Parietal
Sphenoid
Sphenoid fontanelle
What bones make up the asterion (3)
What fontanelle was it
Occipital
Parietal
Temporal
Mastoid fontanelle
What bones make up the bregma (2)
what fontanelle was it
Parietal
Frontal
Ant fontanelle
What bones make up the lamba
What fontanelle did it make
Parietal
Occipital
Posterior fontanelle
What are 4 major sutures
Coronal
Sagittal
Squamous (parieto-squamous and parieto-mastoid)
Lamboidal
What was Dr Sutherlands contribution to OMM, what make him research it, and when did it publish
Thought sutures looked like fish gills and wanted to know there purpose
Discovered CRI and PRM
Published in 1943/1944
Describe Sutherlands vs Modern (moskalenko) in terms of:
- cause of bone mobility
- what drives the PRM
Sutherland:
Bone mobility- due to reciprocal tension membranes
Brain drives the PRM
Modern:
Bone mobility due to CSF flow
Change in blood vol and CSF flow drive PRM
Explain the significance of cranial research?
- Heisey Adams
- Frymann
- Zinakis
Heisey Adams- cat model- cranium moves w/ internal and external forces
Frymann- found SBS SD are common, often out of synch w/ breathing, and the rhythm varies between individuals
Zinakis- confirmed movement and showed it was palpable
What are the unpaired midline cranial bones (6)
Occiput, sphenoid, ethmoid, frontal, vomer, mandible
What are the paired cranial bones (9)
Parietal, temporal, zygoma, “frontal”, maxilla, lacrimal, nasal, palatine, inf nasal concha
What direction and axis do the midline and paired bones move in w/ cranial movements
midline unpaired- transverse axis, sagittal plane (ant/post)
Paired bones- AP axis, coronal plane (ext/int rotation)
What bones does the parietal bone articular w/ (5)
What is special about it w/ regards to fontanelles
What are 2 osteological features that have anatomic relationships?
Other parietal, frontal, temporal, sphenoid, occipital
Contacts all 4 fontanelles (sphenoid, mastoid, post, and ant)
Sagittal sulcus for sagittal sinus
Groove for middle meningeal a
What are examples of SD assoc w/ parietal bone (5)
Cranial synostosis (premature closure of suture), middle meningeal trauma, and Head/neck/tooth pain
With regards to cranial synostosis explain:
- sagittal synostosis
- lambdoid synostosis
- bicoronal synostosis
- unicoronal synostosis
Sagittal synostosis (long thin head)
Lambdoid synostosis (u/l fusion of lambdoid suture-compensatory mastoid process grown on ipsilateral side, tilted base of skull so that its “downhill” on side of SD, and flat back of head)
Bicoronal synostosis (brachycephaly-wide head)
Unicoronal synotsosis (c shaped head)
W/ regards to temporal bone what do newborns lack
Mastoid process
Eustachian tube exits which bone and forms what border?
Eustachian tube exits temporal bone and forms medial wall of middle ear
Explain tinnitus w/ regards to temporal bone movement
Cranial F- ext rotate- low pitch tinnitus
Cranial E- int rotate- high pitch tinnitus
What bone drives motion of the temporal bone
Occiput drives motion of temporal bone
What are temporal bone SD (6)
TMJ/head/neck pain, tinnitus, ear infections (OM), bells palsy
What suture is patent in 10% of population w/ regards to frontal bone
Metopic suture
Frontal bone motion is drive by what cranial bone (kind of the opposite of what drives the temporal bone)
Sphenoid drives frontal bone motion
What are frontal bone SD? (4 w/ 2 assoc)
head pain (assoc w/ dec PRM), sinusitis, visual deficits, anosmia (assoc w/ ethmoid)
Eustachian tube leaves the temporal bone via what exit?
Auditory canal
What are infants more prone to ear infections/otitis media?
Shorter eustachian tube and the tube is more AP
At what time are infants extremely prone to ear infections? Why?
Infants are especially prone to ear infections while teething b/c of extra fluid
At what location is the eustachian tube most likely to be constricted?
Where the temporal bone and sphenoid meet
HA can be assoc w/ what two things and what bone do we treat for them?
Arteries (middle meningeal)
Veins (dural venous sinuses)
Treat the parietal bone
What are the exits for CN 3, 4, 5 (all 3), 6
What bones are involved
CNIII- superior orbital fissure CNIV- superior orbital fissure CNV1- SOF CNV2- foramen rotundum CNV3- foramen ovale CN6- superior orbital fissure
Temporal and sphenoid
What is the path that CNVII goes through and what hole does it exit? What bones are involved and what condition is it assoc w/
CN7- internal auditory meatus -> stylomastoid foramen
Temporal bone - bells palsy
What does CN8 exit? What bone is assoc w it
CN8- internal auditory meatus
Temporal bone
Where is the trigeminal ganglia typically compressed and by what structure; what is the condition called
In meckels cave by dura
Trigeminal neuralgia
What type of joint is TMJ; what bones make it up and what structure stabilizes it
TMJ is synovial joint
Biconvex mandible and saddle temporal bone
Stabilized by meniscus
What direction does the TMJ move when the jaw is depressed
Anteriorly
Muscles of mastiction and what they do
2 muscles open
3 muscles close
2 muscles involved in moving mouth forward and to oppo side
Open- digastric and suprahyoid
Close- temporalis, masseter, medial pterygoid
Forward and to side- lateral and medial pterygoid
Muscles of mouth
- buccinator
- depressor labii inf
- depressor anguli oris
- mentalis
- orbicularis oris
- levator angularis oris
- zygomatic major
- rosorius
Buccinator- blow Depressor labii inf- pout lower lip Depressor anguli oris- draw out corner of lips/frown Mentalis- chin up Orbicular oris- kiss Levator anguli oris- draw up corner/twoface Zygomatic major- smile Rosorius- grimmace/show teeth
Does TMJ affect M or F more?
What condition is it assoc w/?
What are clicks typically due to?
Trauma w/ mouth closed causes what injury?
TMJD F>M
TMJD assoc w/ RA
Clicks due to disc displacement
Trauma w/ mouth closed = post capsule injury
Describe the 3 classes of malocclusions
Class 1- nml bite; slight overbite
Class 2- overbite (2b>2A)
Class 3- underbite
What is the best diagnostic imaging to use for TMJD?
MRI
Describe pain assoc w/ tension HA
The classes based off frequency
Tension HA- band like b/l mild to mod non-throbbing pain
Infrequent 1 per month, frequent <15 per month, chronic >15
Explain theories of tension HA pain (2 theories one regarding periodic and one chronic)
Periodic- peripheral sensitization to myofascial nociceptors
Chronic- CNS sensitization
What 3 muscles are very commonly assoc w/ tension HA
Trapezius, levator scapulae, and SCM
What are some general treatment areas for tension HA?
OA, AA, any SBS, TMJ, t spine, ribs, l spine, sacrum
Describe pain assoc w/ migraine HA
U/l throbbing severe pain w/ assoc symptoms and aura maybe
Describe in general the theory of migraines
serotonin -> vasoconstrict -> dec blood flow -> vasodilate
What is the PRIMARY form of treatment for migraines? When do you typically perform OMT?
Primary- meds
Perform OMT between attacks
Where should you focus OMT for migraines (w/ regards to what nerve); where else should you perform OMT
Sphenoid and temporal bones (CN5)
T spine- paraspinal inhibition and counterstrain
Suboccipital release
Ribs
What is a cervicogenic HA; what are common triggers; what is the major cause; who does it affect more
HA caused by referred pain from C-spine
Triggers- movement or sustained posture
Caused by trauma
F>M
What are the 3 muscles of the suboccipital triangle and their motions
Obliquus capitis sup- SB
Obliquus capitis inf- R
Rectus capitis post sup- SB and R
What is the importance of the myodural bridge?
Directly links MSK to dura
AA joint assoc w/ what neuralgia- where is the pain
C3 neuralgia- what trauma is it assoc w/-where is pain
AA- C2 neuralgia- occipital pain
C3 neuralgia- whiplash- frontal and orbital pain
Explain:
Bulging disc- uneven or even compression?
Herniated- protrusion vs extrusion- what direction
Bulging disc- even compression
Herniated protrusion- no leakage
Herniated extrusion- leakage
Herniation- postero-laterally
What is facilitation?
A pool of neurons are maintained at a subthreshold level of excitation; requires less input to stimulate an impulse; once created can be maintained by the CNS
Explain:
Viscero-somatic reflex
Somato-visceral reflex
Viscero-somatic reflex- visceral stim causes reflex in segmentally related somatic structure
Somato-visceral reflex- somatic stim causes reflex in segmentally related visceral structure
Explain:
Percutaneous reflex of morley
Direct organ to peritoneal inflammation
Explain drainage of lymphatics from GI all the way to veins
GI lymph -> cisterna chyli (L2) -> thoracic duct -> left subclavian v
Lymphatic congestion interferes w/ what?
Medications
Explain the abdominal tension test and what the result indicates
Pt supine and lifts feet just off table- doc presses down on abdomen - if pain dec then it indicates the pain is likely visceral in origin
Explain mesenteric lift treatment and where the doc stands
Small bowl- doc on right side
AC- doc on left side
DC- doc on right side
Cecal lift- doc on left side pull from ASIS towards belly button
