Osteopathic Patient Care Flashcards
Name the 4 principles of osteopathy
1.) Body = mind + body + spirit
2.) Body is self healing and regulating
3.) Body system = function
4.) Rational treatment is based on these 3 tenants
What is somatic dysfunction
Impaired or altered function of related components of the body: skeletal, arthrodial, myofascial, lymphatic
What does TART stand for/mean?
T: Tissue texture changes
A: Asymmetry that is palpable
R: Restrictive range of motion
T: Tenderness
List the 5 types of tissue changes
1.) Temperature
2.) Edema
3.) Moisture
4.) Texture
5.) Tension
Describe temperature as a tissue change in acute and chronic setting
Acute: Temp increased
Chronic: slight increases or decreases (coolness)
Describe texture as a tissue change in an acute and chronic setting
Acute: Boggy, more rough
Chronic: Thin, smooth
Describe moisture as a tissue change in the acute and chronic condition setting
Acute: Increased moisture
Chronic: more dry
Bogginess can be resultant from congestion caused by increased fluid content in the __________________ condition setting. What does bogginess refer to?
Acute texture change
A tissue texture abnormality characterized by a palpable sense of sponginess in the tissue
Describe tension as a tissue change in the acute and chronic condition setting
Acute: Rigid, board like
Chronic: Slight increase, ropy, stringy
Describe tenderness as a tissue change in the acute and chronic condition setting
Acute: greatest tenderness
Chronic: Still present but to a lesser extent
Describe edema as a tissue change in the acute and chronic condition setting
Acute: edema present
Chronic: not present
Describe blood vessels as a tissue change in the acute and chronic condition setting
Acute: venous congestion
Chronic: Neovascularization
Describe erythema test as a tissue change in the acute and chronic condition setting
Acute: redness lasts
Chronic: redness fades quickly or blanching occurs (red reflex)
What is erythema?
Redness due to increased blood flow
Name the 4 barriers to motion
1.) Anatomic
2.) Physiologic
3.) Pathologic
4.) Restrictive
Describe physiologic barrier in relation to ROM
- The natural movement of any joint
- The point to which a patient may actively move a given joint
- Normal ROM
Describe anatomic barrier in relation to ROM
- The point where body joint may supersede physiologic barrier with external force
- The point where the joint may be passively moved past the physiologic barrier
Describe restrictive barrier in relation to ROM
- Exists within the physiologic ROM, between neutral and physiologic ROM
- What is dx when palpating somatic dysfunction
Describe pathologic barrier in relation to ROM
- Result of trauma or disease
Name the 3 main anatomic planes
- Coronal
- Sagittal
- Transverse
What does the coronal plane separate?
Anterior vs Posterior
What does the sagittal plane separate?
R v L
What does the transverse plane separate
Inferior & Superior
List the 3 main axes
1.) Vertical
2.) Transverse
3.) Anterior Posterior
Describe the vertical axis
Running from top of head to feet at the midline
Describe the transverse axis
Through the pelvis from L to R
Describe the anterior posterior axis
Running through belly button Front to back
The motion of flexion/extension is along the _______________ plane and the __________________ axis
Sagittal plane
Transverse axis
Flexion increases or decreases the angle
Decreases the angle
Extension increases or decreases the angle
Increases the angle
The motion of rotation is along the _______________ plane and the __________________ axis
Transverse plane
Vertical axis
The motion of side bending along the _______________ plane and the __________________ axis
Anterior posterior axis
Coronal plane
Neutral spinal mechanics occur in the absence of: _____________________ _____ ______________________ &
Flexion or extension
At normal posture
Non-neutral mechanics occur:
In either flexed or extended position
How many principles comprise Fryette’s principles?
3 principles
Describe Fryette’s First Principle
In neutral, side bending and rotation occur in OPPOSITE direction
Type 1: group dysfunction
Describe Fryette’s Second Principle
Flexion/Extension: side bending & rotation occur in the SAME direction
Type 2: Single segment
To what parts of the spine do Fryette’s principles apply?
Thoracic and lumbar only
Desrcibe Fryette’s Third Principle:
Motion in any one plane limits motion in other
Type I (_________________________) Mechanics: N-S-R dysfunctions, the side bending precedes rotation and: _________________ ___________________, then _________________________ occurs TOWARD the convexity
Neutral
produces concavity
Rotation
Type II (__________________) Mechanics: In the _____________________ or ____________________ position if a __________________ ____________________ ROTATES, it forces side bending in the SAME direction
Non-neutral
Flexed
Extended
SINGLE vertebrae
T/F: Sid bending and rotation are always coupled according to Fryette’s Principles and occur in the same direction
False, only in flexion or extension (Type II) are they in the same direction
Coupled does not mean same direction
Describe a “Focused/problem oriented history”
For specific complaints, i.e. cough
What is the correct term for “surgical clearance”
Presurgical evaluation
List 4 possible components of a “Health maintenance/preventative visit”
Screenings
Smoking cessation
Weight loss
High risk sexual behavior
When is it appropriate to use closed ended questions?
During Review of systems & clarifying information
Subjective components of a patient encounter include:
___________________
___________________
Medical history of patient
Surgical history of patient
Allergies
______________________
Family history
Social history
HPI
ROS
Medications taken and what they are supposed to be taken
What is an HPI?
All the questions related to what brought the patient into clinic
Questions to figure out what is going on
What is the acronym for all portions of the HPI?
OLD CARRATS
After the first component of Chief Complaint, what does
O
L
D
stand for in the HPI acronym?
Onset
Location
Duation
After the chief complaint and OLD, what does
C
A
R
R
A
T
S
stand for when referring to the HPI?
Characteristic: description-achy, sharp, burning, stabbing
Aggravating Factors
Relieving
Radiating
Associated symptoms
Timing/Temporal
Severity
What are “associated symptoms”?
Chief complaint: URI
ASSOCIATED SYMPTOMS: fever, sore throat, runny nose
What is the pain scale used for pediatric or non-verbal patients?
FLACC pain scale
What are some questions that might be included in a social history?
1.) Occupation
2.) Relationship status
3.) Sexual status & orientation
4.) Habits
5.) Spiritual
6.) LMP
What is the more precise verbiage for toboacco/smoking history?
“Do you use any form of nicotine?”
What are the parameters for orthostatic hypotension?
Systolic drops more than 20 mmHg
Diastolic drops more than 10 mmHg
Right iliac crest higher than the left will indicate:
Right lumbar sidebending
Type 1 disfunction involves:
Long restrictor, i.e. erector spinae
Brings things lateral from the muscle closer together
Left shoulder lowered indicates:
Left side bending
Heightened left iliac crest indicates:
Left side bending
What is the main difference between myofascial release and soft tissue techniques
Myofascial release
Soft tissue technique is used to:
Treat general areas of hypertonic muscle
When can soft tissue techniques be considered myofascial technique?
If there is a diagnoses of tissue motion preference made and treated
Myofascial Release is:
Based on a specific tissue diagnosis of motion preference OR the direction of fibers
Soft tissue uses what kind of motion?
Repetitive & rhythmic motion
Myofascial release uses:
Sustain pressure until myofascial creep is not appreciated anymore under the tissue
What is prone lumbar soft tissue lumbar technique?
Patient is prone, 1 hand on paraspinal muscles on side away from practitioner
Second hand will connect with ASIS
Light pressure on the paraspinal muscles, lift the ASIS toward practitioner
Lower ASIS with sustained light pressure on paraspinal muscles
What is the indication for Prone Lumbar Soft Tissue technique?
Thoracic or lumbar paraspinal muscle tension associated with back pain, chest wall pain
What is Lumbosacral prone two handed traction soft tissue technique?
When might this technique be considered myofascial?
1.) Hands crossed in an “X” formation, apply slight pressure, and move hands away from teach other
2.) If find an area of hypertonicity, can hold the traction until resistance of muscles decreases
What are the indications for Lumbosacral prone two-handed traction technique?
Lumbosacral tension related to back pain, SI pain, pelvic pain
What areas of the back can two-handed traction technique be applied?
Thoracic and Lumbar region
What is prone regional thoracic myofascial release technique?
- Start medial to spinous process and inferior angle of scapula
- Up, down, left & right, rotate clockwise, counterclockwise
- Physician can engage tissue indirectly or directly
- Force is held 20-60 seconds or until a release is palpated
- Repeat until resistance is no longer found
What is Mid and Lower Thoracic region soft tissue technique
- Want to stretch muscle fibers perpendicular to their direction
- Patient laying on side
- Patient arm over top forearm closest to the head
- Physician applies force and stretch, hold, and slowly release
- Repeat in rhythmic and kneading fashion
What are the indications for mid and lower thoracic region soft tissue?
Reduce muscle hypertonicity, muscle tension, fascial tension and muscle spasm
What are the indications for prone regional thoracic myofascial release technique
Reduce muscle tension, fascial tension. Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures
What is pectoral traction?
- Patient is supine
- Find pectoralis major at midaxillary line & hook under the pec muscle
- Lift the pec muscle while patient has hands on their belly button
- Patient breathes in and out while hold of pectoralis is sustained
Is pectoral traction direct or indirect treatment? Why
Direct
What are indications for pectoral traction?
Increase venous and lymphatic drainage to alleviate congestion associated with decreased A-P diamete of thorax
- Atelectasis, bronchitis, pneumonia
- Improve excessive protration of shoulder
Release tension of clavipectoral fascia
What is the thoracic inlet?
Borders of T1-First rib-manubrium (bone that forms jugular notch)
What is thoracic outlet?
Bounded by scapula, first rib on lateral, clavicle
- Looking from top down
What are biaural tubes?
The metal portion of ear pieces
What is the diaphragm of the stethoscope?
The flat portion which touches the patient skin
The smaller side of the stethoscope is traditionally used for pediatrics listening to heart, lungs, abdomen. When might you use this side on adults?
To listen to the carotid artery on an adult
The diaphragm of the stethoscope is used to hear what sounds?
What does the bell of the stethoscope used for?
Diaphragm: High frequency sounds
Bell: lowest frequency sounds
How do you use the stethoscope to differentiate murmors from bruits/regurgitation?
Murmors use: Diaphragm
Regurg: Bell
List the 4 layers of Fascia
- Pannicular
- Axial and Appendicular
- Meningeal
- Visceral
Describe pannicular fascia
Loose and dense irregular connective tissue
Variable fat content
Describe axial and appendicular fascia
Surrounds the muscle and the torso, fibers tend to to run in the direction of the muscle fibers
What layer of fascia matches this description? Loose and dense irregular connective tissue
Variable fat content
Pannicular
What type of fascia matches this description?
- Surrounds the muscles and torso, fibers tend to run in the direction of the muscle fibers
Axial and appendicular
What type of fascia matches this description
Dural and other membranes surrounding the CNS
Meningeal
Describe meningeal fascia
Dural and other membranes surrounding the CNS
Where is visceral fascia?
Mediastinum (chest cavity region), other surrounding organs
Where is subserous fascia?
Describe it
- Loose, elastic tissue
- Covering peritoneum and visceral pleura
- Area can accumulate inflammatory cells
T/F: Fascia is continuous with bone, muscle, tendon
True
What is compartment syndrome?
- Swelling/infection within a body compartment stops blood flow = necrosis
The 7 “P’s”
Pain
Pallor
Pressure
Paresthesia
Paralysis
Pulseless
Cold (Poikilothermic)
are used to diagnose
Compartment syndrome
What is a common cause of compartment syndrome?
Crush injury, i.e. dropping a safe on your foot
What is elasticity?
Recoverable deformation
What is plasticity?
Nonrecoverable deformation
What is viscosity?
The rate of how quickly the fascia moves
I.e. injured fascia moves less while normal fascia moves quickly
What is stress?
When place tension on the bicep, the stress is distributed throughout all the fascia of the region
When fasica cannot be stressed such that the effect of a force is NOT normalized over an area, what happens?
Increase risk of injury
What is strain?
The a result of prolonged stress that the tissue has been reformed/reshaped and preserves its new shape
What is Plastic deformation
Stressed, formed, or molded tissue preserves its new shape
What is elastic deformation?
A stress, formed or molded tissue recovers its original shape
What is creep?
What is an example of creep?
Fascia has undergone plastic deformation
As applied myofascial treatment, feel the fascia return to its normal position
What is Hooke’s Law
1.) Strain or deformation placed on an elastic body is proportional to the stress or force placed upon it
2.) An applied stretch or compression to a tissue results in proportional change in length
3.) Fascia meets the demand upon it
What is Hooks Law in simpler terms:
The strain or deformation placed on an elastic body is proportional to the stress or forced or placed on it
The more force placed on something, the more deformation occurs
What is Hooke’s Law in simpler terms:
An applied stretch or compression to a tissue results in a proportional change in length
If there is applied stress, the fascia will lengthen overtime
T/F: Wolff’s law of “form follows function” is applicable to every part of the body
True
Direct fascial release engages what barrier?
Restrictive barrier
Force is maintained until release is felt
In direct fascial release, there is engagement of the restrictive barrier where force can be applied in what direction(s)
Perpendicular or parallel
____________ fascial release utilitizes the point of ease during passive range of motion, where elastic forces are in balance.
Indirect fascial
Myofascial release uses _____________ vs ______________ and direct vs. indirect
Perpendicular vs parallel
Soft tissue is used to treat
General hypertonicity of an area
What is the goal of myofascial release?
Diminish restrictions in physiologic range of motion
Used to ease tension within sheets of fascia
Muscle energy requires
Patient actively using their muscles
Muscle energy requires
Patient actively using their muscles
__________ __________ tones inactive muscles which are weak
Muscle energy
__________ __________ tones inactive muscles which are weak
Muscle energy
What is an example of Inherent motion?
Respiration
What is the elastic range?
The barrier intermedium between physiologic and anatomical barriers
Direct treatment:
Starts by engaging the restrictive barrier
Indirect Treatment:
Starts by moving away from the restrictive barrier
What is concentric contraction?
Contraction of a muscle resulting in the approximation of insertion and origin
-Flexion
Eccentric contraction:
Muscle tension allows insertion and origin to separate to LENGTHEN
- extension
What is isolytic contraction?
When external forces overcome muscle contraction
i.e. dropping a weight that is too heavy to lift
- External force is the weight
- Muscle contraction was trying to lift
When a Golgi Tendon reaches a critical tension it produces:
Relaxation to prevent damage
If part of a muscle is hypertonic, what happens to the other portions of the same muscle?
Muscle spindle sends signal for contraction over the muscle
What are monoarticular muscles
Short restrictors
Maintain type II segmental dysfunction
What are polyarticular muscles
Long restrictors
Maintain Type I dysfunction
What is Post-isometric relaxation?
What is the force applied?
- When muscle is in refractory period where contraction cannot occur we stretch the muscles to normal lengfht
- Force: Sustained gentle pressure
Post isometric relaxation uses muscle spindle, golgi tendon organ, or reciprocal inhibition?
Golgi tendon organ
What is Joint mobilization using force?
Using muscles around a joint to force a joint through a restrictive barrier
What is the purpose of Joint mobilization?
Restore joint motion by using muscle contractions to free up restricted motion using force
What is respiratory assistance?
- Form of muscle energy
- Improve physiology with voluntary respiratory motion to reduce rib dysfunction
What is oculocephalic reflex?
What might be a indication for this treatment?
- Body following where eyes move to improve C1/C2 dysfunction
What is reciprocal inhibition?
- Lengthen/relax hypertonic muscle by contracting the antagonist muscle
- Form of gentle muscle energy
__________ ____________ law is described as: when a muscle receives a nerve impulse to contract, its antagonist receives, simultaneeously, an impulse to relax
Sheerington’s Second Law
Sherrington’s second law is applicable to what form of muscle energy technique?
Reciprocal inhibition
What is crossed extensor reflex?
Similar to reciprocal inhibition but using muscles on the OPPOSITE side of the body
What is particularly useful about crossed extensor reflex?
Can relax hypertonic muscle on an acute injury side by inducing contraction of the opposite side
What is isokinetic strengthening
Strengthening of weakend muscle
Which muscle is weakened and which is hypertonic in isokinetic strengthening?
Contracted muscle is hypertonic
Its AGONIST is weakened from being consistently relaxed
Isolytic lengthening is a more invaisve muscle energy treatment, why?
It is used in cases where the tissue is approaching a pathologic barrier
When might you be particularly concerned about inappropriate excessive force on tendons
Long term use of steroids can make tendons more prone to rupture which would:
Principles of Tx Muscle Energy:
1.)
2.) Physician directs patient to contract appropriate muscle
3.) Physician applies counterforce equal to patient contraction and ________ _____________ until _________ _________ ___________ ___ _________
4.) Patient is to relax and physician matches relaxation
5.) Take up slack permitted by the procedure: move patient further into restrictive barrier
6.)_______________
7.)
1.) Place patient into restrictive barrier
2.) Physican applies counterforce equal to the patient contraction and maintains force until appropriate patient contraction is perceived at monitored area
6.) Repeat 5-7 times
7.) Return patient to restrictive barrier once more and then place patient to neutral
When trying to lengthen a muscle, what might be your first step?
Address weakness of the antagonist muscle and strengthen prior to lengthening the hypertonic agonist
