osteopathic Skills 1 (ROM/Restrictive factors) Flashcards
What is the available AROM for the cervical spine?
Flex, Ext, Rot, S/bending
What is the orientation of the facets?
Which plane do they reside within?
Flex 80-90
Ext 7
Rot 20 to 45
S/bending 70 to 90
45 degree coronal (C2 to C7)
C1 transverse
Which muscles Flex the cervical spine?
Anterior scalene
Longus colli
Longus capitis
SCM
What are the limiting factors to flexion of the cervical spine?
Apprehension Ligamentous Structural Joint capsule Opposing muscles
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Adipose tissue – Generating soft end feel
Muscular (Opposing muscles of extension) Upper fibers of the trapezius Levator scapulae Splenius cervicis and Splenius capitis Semispinalis and spinalis capitis Cervicis portion of erector spinae Sub-occipitals
Ligamentous: Nuchal ligament Interspinous Ligaments Ligamentum flavum Posterior longitudinal ligament
Joint Capsule
Posterior stretch of zygapophyseal joint
(stretching the capsule)
Structural
Posterior intervertebral joint opens
Anterior intervertebral joint closes
Which muscles Extend the cervical spine?
Upper fibers of the trapezius Levator scapulae Splenius cervicis and Splenius capitis Semispinalis and spinalis capitis Cervicis portion of erector spinae Sub-occipitals
What are the limiting factors to extension of the cervical spine?
Apprehension Ligamentous Structural Joint capsule Opposing muscles
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Ligamentous
Anterior longitudinal ligament
Structural
Sp’s come together (kissing syndrome)
Anterior facet capsule will stretch
Posterior intervertebral joint closes
Anterior intervertebral joint opens
Muscles of flexion (e.g. scalene) Platysma Anterior scalene Longus colli Longus capitis SCM
Which muscles side bend the cervical spine?
SCM (Same side) Longus colli and capitis (SS) Trapezius (SS) Splenius capitis and cervicis (SS) Intertransversarii Levator scapulae Scalenes
What are the limiting factors to side bending of the cervical spine?
Apprehension Ligamentous Structural Joint capsule Opposing muscles Joint mechanics
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Ligamentous Intertransverse ligament (joint TP to TP)
Opposing side bending muscles
Structural
Stretch of capsule on contralateral side
(joint opens)
Compression of capsule on ipsilateral side
(joint closes)
Mechanics
Side bending and rotation coupled to the same side
Which muscles rotate the head and neck?
Splenius capitis and cervicis (SS) SCM (OS) Scalenese anterior (OS) Longus colli (OS) Rotatores (OS) Multifidi (OS)
What are the limiting factors to rotation of the cervical spine?
Apprehension Ligamentous Structural Joint capsule Opposing muscles (2 suboccital muscles) Joint mechanics
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Ligamentous
Apical/ Alar ligaments (Odontoid processs)
Joint Mechanics
Rotation and side bending are coupled to the ipsilateral side (type 2 mechanics)
Opposing muscles of rotation Rectus Capitis posterior major Obliquus capitis superior SCM Trapezius Splenius capitis and cervicis (SS) Intertransversarii Levator scapulae Scalenes
Structural
Stretch of capsule on contralateral side
(joint opens)
Compression of capsule on ipsilateral side
(joint closes)
Mechanics
Side bending and rotation coupled to the same side
What is the Origin (2), insertion (2), action and nerve innervation of the SCM?
Which condition effects the SCM during infancy?
Origin
Sternal head: superior part of anterior surface of manubrium
Clavicular head: superior surface of medial third of the clavicle
Insertion
Lateral surface of mastoid process of the temporal bone, Lateral half of superior nuchal line of the occipital bone
Action
Contralateral
Rotation
Ipsilateral
Side Bending
Bilateral
Flexion
Nerve innervation Accessory nerve (CN XI) cervical plexus (C2-C3)
Pathology
torticollis
What is the Origin, insertion, action and nerve innervation of the Trapezius?
Origin Superior nuchal line External occipital protuberance Nuchal ligament Spinous processes of vertebrae C7-T12
Insertion
Lateral one-third of the clavicle
Acromion process
Spine of scapula
Nerve
accessory nerve (motor)
cervical spinal nerves C3 and C4
Action
Rotation
Retraction, elevation, and depression of scapula
Upward rotation of the scapula
What is the Origin, insertion, action and nerve innervation of the Splenius capitis?
Origin
Nuchal ligament and spinous process of C7-T3
Insertion
Mastoid process of temporal and occipital bone
Action
Extend, rotate, and laterally flex the head
Nerve Innervation
Cervical plexus C3,4
What is the Origin, insertion, action and nerve innervation of the Splenius cervicis?
Origin
Spinous processes of T3-T6
Insertion
Transverse processes of C1-C3
Action
Bilaterally: Extend the head & neck, Unilaterally: Lateral flexion to the same side, Rotation to the same side.
Nerve Innervation
Posterior rami of lower cervical nerves
What is the Origin, insertion, action and nerve innervation of the Levator scapulae?
Origin
Posterior tubercles of transverse processes of C1 - C4 vertebrae
Insertion
Superior Angle of the scapula
Action
Elevates scapula and tilts its glenoid cavity inferiorly by downwardly rotating the scapula
Side bends/rotates to the ipsilateral side
Bi laterally extends the neck
What is the Origin, insertion, action and nerve innervation of the sub occipital muscles?
- Rectus capitis posterior major muscle
- Rectus capitis posterior minor muscle
- Obliquus capitis superior muscle
- Obliquus capitis inferior muscle
- All muscles innervated by the nerve to the sub occipitals, C1*
1. Rectus capitis posterior major muscle Origin Spinous process of the axis (C2) Insertion Inferior nuchal line of the occipital bone
- Rectus capitis posterior minor muscle
Origin
Posterior tubercle on the posterior arch of the atlas
Insertion
Medial part of the inferior nuchal line of the occipital bone and the surface between it and the foramen magnum
3. Obliquus capitis superior muscle Origin Lateral mass of atlas (TP) Insertion Lateral half of the inferior nuchal line
4. Obliquus capitis inferior muscle Origin spinous process of the axis Insertion lateral mass of atlas
What is the available AROM for the thoracic spine?
Flex, Ext, Rot, S/bending
What is the orientation of the facets?
Which plane do they reside within?
60 degree orientation within coronal plane
Flexion 20 to 45
Extension 25 to 45
Rotation 35 to 50
S/bending 20 to 40
Which factors contribute to thoracic flexion?
Gravity Psoas contracting eccentrically Rectus abdominis Internal oblique External oblique
What are the limiting factors of the thoacic spine flexion?
Apprehension Ligamentous Structural Joint capsule Opposing muscles Joint mechanics
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Structural Visceral Adipose Tissue Posterior stretch of facet joint capsule (Joint opening) Facet opening closing Sternum Ribs
Ligamentous Posterior longitudinal ligament Ligamentum flavum Interspinous ligament Supraspinous ligament
Opposing muscles
Muscles of the back (erector spinae )
Quadratus Lumborum
Which muscles produce extension of the thoracic spine?
Serratus posterior inferior Quadratus lumborum Erector spinae muscles (superficial and deep) Interspinalis Intertransversarrii
What are the limiting factors of the thoacic spine extension?
Apprehension Ligamentous Structural Joint capsule Opposing muscles *think muscles of respiration*
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Structural
Anterior facet capsule will stretch (joint will open)
Posterior facet capsule (joint will close)
Orientation of the facets (they start to pinch at the lower pole)
Spinous processes overlap (compressing together)
Compression of the ribs
Ligamentous
Anterior longitudinal ligament
Muscles *INTERCOSTALS* Psoas contracting eccentrically Rectus abdominis Internal oblique External oblique
Which muscles produce rotation of the thoracic spine?
When the orgin moves towards the insertion, the latissimus dorsi acts as a powerful rotator of the trunk
Rectus abdominis
Internal oblique
External oblique
What are the limiting factors of the thoacic spine rotation?
Apprehension
Ligamentous Take into account ligaments of the ribs
Structural
Joint capsule
Opposing muscles think muscles of respiration
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Spinal mechanics
Type 1 coupled motion
Rotation and side bending to the contralateral side
Ligamentous
Intertransverse ligament
Ligaments surrounding the facet joints will stretch
Ribs
(Radiate ligaments/costotransverse ligament)
Opposing musculature Opposing erector spinae muscles Rectus abdominis Internal oblique External oblique Quadratus lumborum Lats When the orgin moves towards the insertion, the latissimus dorsi acts as a powerful rotator of the trunk
What is the available AROM for the Lumber spine?
Flex, Ext, Rot, S/bending
What is the orientation of the facets?
Which plane do they reside within?
Flexion 40 to 60
Extension 25 to 35
Rotation 3 to 18
S/bending 15 to 20
What is the orientation of the facets?
L1 to L4 Sagittal orientation 90 degrees
L5/S1 Coronal orientation 45 degrees
Which muscles produce flexion of the lumber spine?
Gravity
Rectus abdominis
Abdominal oblique muscles (internal and external)
Psoas major/minor (eccentrically)
Which muscles produce extension of the lumber spine?
Deep and superficial erector spinae muscles
Intertransversarii
Interspinalis
Quadratus Lumborum
Which muscles produce lateral flexion of the lumber spine?
Quadratus lumborum
Psoas major
Internal and external obliques
Superficial erector spine
Which muscles produce rotation of the lumber spine?
Levator costorums
Deep erector spinae muscles
Internal and external oblique
Which factors limit flexion of the lumber spine?
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Adipose tissue/Viscera
Spinal mechanics/orientation
Orientation of the facet joints – stretch at posterior
Ligamentous Posterior longitudinal ligament Supraspinous ligament Interspinous ligaments Ligamentum flavum
Muscular
Hamsrings
Muscles of extension
Hydration of discs
Presence of intervertebral discs
Which factors limit extension of the lumber spine?
Psychological apprehension due to eliciting pain
Skin and fascia on opposing side
Adipose tissue/Viscera
Structure
Orientation of the facet joints – joints close posterior and open anterior
Approximation of SP’S
Size of the vertebral bodies
Ligamentous
Anterior longitudinal ligament
Linea alba
intervertebral discs
Disc Hydration
Musculature
Stretch in muscles of flexion
Which muscles perform laterally flexion of the lumber spine?
Quadratus lumborum
Psoas major
Internal and external obliques
Superficial erector spine
Which factors limit rotation of the lumber spine?
Structural
Orientation of the facet joints
L1 to L4 adhere to 90 degree sagittal orientation
This limits movement due to the coupled motion of the lumber spine with rotation and side bending being coupled to the contralateral side
Size of the vertebral bodies
Ligamentous
Interspinous ligaments
Intertransverse ligaments
Hydration
Presence of intervertebral discs
Opposing side bending muscles
Which muscles perform side bending of the lumber spine?
Quadratus lumborum
Psoas major
Internal and external obliques
Superficial erector spine
Which factors limit lateral flexion of the lumber spine?
Structural
Orientation of the facet joints
L1 to L4 adhere to 90 degree sagittal orientation
This limits movement due to the coupled motion of the lumber spine with rotation and side bending being coupled to the contralateral side
Size of the vertebral bodies
Ligamentous
Intertransverse ligament
Hydration
Presence of intervertebral discs
Musculature
Opposing side bending muscles
What is the ROM of the shoulder joint?
Flexion 180 Extension 50 Abduction 180 Adduction 10 to 55 External rotation 80 Internal rotation 60
What is the ROM of the elbow joint?
Flexion 140/150
Extension 10 to 15
Supination 90
Pronation 90
Which ligament restricts supination/pronation of the elbow joint?
Tip begins with a Q.
Quadrate ligament
