Osteopathic considerations in MSK dysfunction + peds orthopedics Flashcards
median entrapment neuropathy \
d
Carpel tunnel syndrome
Anterior Interosseous Membrane syndrome
Pronator Teres syndrome
Other sites around the elbow
– distalhumerusby theligament of Struthers
– proximal elbow by a thickened biceps aponeurosis
– proximal forearm by a thickened proximal edge of the flexor digitorum superficialis muscle
OMT for carpal tunnel
Intercarpal Articulatory Technique
Carpal Tunnel Myofascial Release
Lymph treatment
Nerve glide
anterior interosseous membrane OMT
Radial Head treatment MFR for forearm and IOM BLT for forearm and IOM Counter strain to forearm Nerve glide
OMT for pronator teres syndrome
Muscle energy Counterstrain Myofascial release Olecranon articulatory treatment BLT Radius treatment Nerve glide
what muscles does the main part of the median nerve supply
Superficial group:
Pronator teres
Flexor carpi radialis
Palmaris longus
Intermediate group:
Flexor digitorum superficialis muscle
what does the anterior interosseous branch of the median nerve supply
Deep group:
Flexor digitorum profundus(only the lateral half)
Flexor pollicis longus
Pronator quadratus
what muscles in the hand are innervated by median nerve
1st and 2ndlumbricalmuscles.
It also supplies the muscles of thethenar eminence (by a recurrent thenar branch).
The muscles of the hand supplied by the median nerve can be remembered using themnemonic, “LOAF” forLumbricals1 & 2,Opponens pollicis, Abductor pollicis brevis andFlexor pollicis brevis. (NB: OAF are the thenar eminence)
anterior heel pain
lots of running
ice stretching and NSAID’s help some
worse with initial standing and starting to run
plantar fasciitis
where are the pinch points of the median nerve
thoracic outlet
- 1st rib
- clavicle
- scalenes
Axilla
Cubital area
Interosseous membrane
carpal tunnel
frog leg X-ray
better idea of femoral head position in the acetabulum
Slipped capital femoral epiphysis (SCFE)
Noninflammatory condition
Typically overweight boys
Endocrine disorders
Can be associated with hypothyroidism, or pituitary deficiencies
Acute slip
Preceding hx of minor trauma
Present with pain & inability to walk
*Subacute/chronic slip
Sx are typically insidious—pain in affected hip or limp
bilateral in up to 30%
severity scale of SCFE
mild—
OMT for SCFE
Goal:
Directed toward improving vascular and lymphatic circulation
How we get there
Improve and balance muscular tone across the joint and in the areas above and below
From above: psoas, erector spinae, abdominals, innominates, sacrum, junctions
From below: quads, hams, adductors, abductors, knee, ankle, foot
BLT
Counterstrain
Tucker is a 12 year old Caucasian male presenting with his mother complaining of bilateral knee pain that began 3 months ago and has gotten progressively worse. Physical exam reveals tender and warm nodules over anterior superior aspect of the tibias bilaterally.
Osgood schlatter disease
Most common pediatric overuse syndrome May be benign, self-limiting Girls: 8-13 yo Boys: 10-15 yo May occur after getting kicked in soccer 20% of all young athletes 20% of cases are bilateral
Repetitive, tensile forces on developing tibial tubercle.
Pain over tibial tubercle with activity, especially eccentric contraction of quadriceps.
Tenderness and swelling over tubercle.
Type I - soft tissue swelling only
Type II – Xray evidence of fragmentation
how do you use OMT to treat osgood schlatter
OMT to address any contributing mechanical strains/stresses
Tibial rotation
Hip restriction
Rehab exercises to maintain balance between quadriceps and hamstrings
Activities do not need to be curtailed
Ice, NSAIDS only when severe
Conservative treatment works with improvement of symptoms
use Muscle energy: pelvis hip rotators quads/hamstrings tibial mechanics fibula foot
