Osteopathic Skills Postural Exam

Question 1

Describe the orientation, curvature and plane the following vertebrae reside within

1. Atlanto occipital joint (AO)
2. Cervical
3. Thoracic
4. Lumber (L1 to L4)
5. L5/S1

Answer 1

Atlanto occipital joint (AO) Transverse Retains level of the eyes on the horizon Cervical 45 degrees Coronal Lordotic Thoracic 60 degrees Coronal Kythotic Lumber L1-L4 (Sagittal) 90 degrees L5/S1 45 degrees Coronal .

Question 2

During a postural assessment what would you always compare to generate a three dimensional view?

Answer 2

*Always state that you would compare the anterior, posterior and lateral views in order to make a clear comparison

Question 3

Prior to assessing the mid gravitational line what would you assess?

Answer 3

Skin/Musculature

Question 4

Prior to performing a postural examination, what type of consent must be gained?

Answer 4

Verbal

Question 5

State the following junction levels Cervicodorsal/thoracic junction Thoracolumbar junction Lumbosacral junction

Answer 5

Cervicodorsal/thoracic junction C7/T1 Thoracolumbar junction T12/L1 Lumbosacral junction L5/S1

Question 6

State the levels of the following 1. Apex of the lungs 2. Superior Angle of the scapula 3. Aortic Arch 4. Apex of the heart 5. Tip of the 12th rib

Answer 6

C7/T1 Apex of the lungs T2 Superior Angle of the scapula T4 Aortic Arch T10 Apex of the heart L2 Tip of the 12th rib

Question 7

State what the following landmarks are in line 1. Most prominent cervical spinous process 2. Superior Angle of the scapula 3. Spine of the scapula 4. Inferior angle of the scapula 5. Iliac crest 6. PSIS

Answer 7

C7 Most prominent cervical spinous process T2 Superior Angle of the scapula T3 Spine of the scapula T7 Inferior angle of the scapula L4 Iliac crest S2 PSIS

Question 8

What anatomical landmarks contribute towards the formation of the lateral plumb line?

Answer 8

An imaginary plumb line cutting the body into an anterior and posterior right-hand side. • External auditory meatus • Acromion process • Third lumber vertebrae L3 (Centre of the abdomen) • Greater trochanter of the hip • Lateral condyle of the femur • Lateral malleolus of the fibula

Question 9

What assessing the CD junction, what are you assessing?

Answer 9

• Transitional junction between a lordotic and kyphotic curvature • Any indication of a dowager’s hump Fatty tissue deposit associated with postmenopausal women (Architecture of the vertebrae changes anteriorly)

Question 10

What factors could influence posture?

Answer 10

• Mental health (Depression/anxiety) • Antalgic (Deviating away from pain/Sleep deprivation) • Illness/disease (Fibromyalgia, osteomalacia, mal-alignment due to the healing of fractures, degenerative changes) • Pregnancy • Postural adaptations (muscle weakness, scoliosis, rigidity/elasticity in tissue)

Question 11

What landmarks contribute towards the formation of the anterior mid gravitational line?

Answer 11

An imaginary line cutting the body into a left- and right-hand side. Crown, nose, mentum, suprasternal notch, symphysis of the sternum, linea alba, pubic symphysis, between the centre of the feet.

Question 12

What landmarks contribute towards the formation of the posterior mid gravitational line?

Answer 12

An imaginary line cutting the body into a left- and right-hand side. Running from the crown, the EOP, C7, the spinous processes of the vertebrae, through the gluteal cleft and ending between the centre line of the feet.

Question 13

Which assessing the Calcaneus, Malleolus or Achilles Tendon, what are we assessing?

Answer 13

• Deviation of the calcaneus influenced by the position of the arches of the feet • The height of the malleoli can be influenced by the arches of the feet or a torsion via the tibia, length of the tibia, femur, development of the hip. • Any indication of thickening Tendinosis (Chronic) – disarrangement of muscle fibres Tendinitis (Acute) – Trauma which has triggered inflammatory response that does not have microscopic damage

Question 14

Which assessing the feet/toes, what are we assessing?

Answer 14

• Position of the feet (Influenced by the position of the hip) • Skin formation gives an indication of uneven weight bearing/distribution Arches of the feet • Pes planus (low medial longitudinal arch) • Influences the hip to enter into a position of internal rotation • Generates a valgus stress through the knee joint • Muscles of the lateral compartment of the leg placed into a forced shortened position • Calcaneus becomes everted (supinated) • Pes Cavus (High medial longitudinal arch) • Influences the hip to enter into a position of external rotation • Generates a varus stress through the knee joint • Muscles of the anterior compartment of the leg enter into a forced shortened position • Calcaneus becomes inverted (pronated) • Hammer Toes (Abnormal bend in the intermediate phalanx to compensate for uneven weight displacement) • Bunions (Projection which forms at the base of the 1st metatarsal phalangeal joint)

Question 15

Which assessing the knees, what are we assessing and looking out for?

Answer 15

• Is the knee held in a flexed, neutral or hyperextended position? • Hyperextension- may indicate hypermobility • Flexed- may indicate an inability to extend Loose body present within the knee joint • Engagement of the screw home mechanism Quadriceps disengages Genu vagum/Varum

Question 16

Which assessing the lateral plumb line, what areas are you looking for upon examination?

Answer 16

Weight Distribution/Displacement Neck Cerviothoracic junction Height/Position of the shoulders Scapula Thoracic spine/Cage Abdomen/Pelvis iliac crest level/Glute development Thigh and leg development position of the knees Feet/Toes

Question 17

Which assessing the neck, what are you assessing?

Answer 17

• Curvature of the cervical spine (Hyper/Hypo lordotic) • Any deviation out with the plumb line of the body. • In indication of lateral flexion, Anterior/ Posterior translation or rotation? • Muscularity of the flexors/extensors of the head and neck Sub-occipital forced into a forced shortened position (Arnold’s neuralgia) • Height of the mastoid process of the temporal bones, the level of the eyes, zygomatic arch. • Levels of the ears/ Angle of the mandible Any indication of hypertrophy/atrophy/tenderness/tissue texture changes

Question 18

Which assessing the scapula, what are you assessing?

Answer 18

• Position of the scapulae in relation to the appropriate spinal levels • Position in relation to the mid-line (Abduction/Adduction) • Any indication of winging, upward or downward rotation. Weakness of the serratus anterior or palsy to the long thoracic nerve of bell. • Muscularity development which attaches to the posterior surface of the scapulae.

Question 19

Which assessing the shoulders, what are you asssessing?

Answer 19

• Are the shoulders held in a position of internal or external rotation? • Is the shoulder girdle held in a position of protraction, retraction, elevation due to muscular or structural influence? • Muscular development, tone, hypertrophy, atrophy of the muscles of the shoulder complex/joint • Position influenced by curvature of the spine, muscles which act on the joint. • Shoulders elevated to guard tender tissue • Step deformity of the A/C Joint? • Any indication of one shoulder being internally or externally rotated due to muscular or kyphotic influence?

Question 20

Whilst assessing the abdomen/pelvis/lumber spine, what are you assessing?

Answer 20

• Curvature of the lumber spine (Lordotic) • Hyperlordotic curve due to an anteriorly rotated pelvis • Hypolordotic curvature due to a posteriorly rotated pelvis • Scoliosis? Rotation? Lateral flexion? • Any indication of lower cross syndrome? • Any indication of hypertrophy, hypotrophy of the muscularity crossing the lumber spine • Is the abdomen protruding, core development due to being overweight, pregnancy or congenital factors?

Question 21

Whilst assessing the skin, what are you looking for?

Answer 21

• Pigmentation of the skin (discolouration) • Any areas of redness (may indicate infection/inflammation/oedema) • Any areas white areas/Ischemia • (may indicate blood supply is inhibited) • Cuts, ecchymosis (bruising), lumps, bumps • Dry skin (eczema, psoriasis, diabetes, hypothyroidism, and malnutrition are all associated with dry skin) • Hair formation (Faun’s beard) • (marker for its underlying spine and spinal cord anomaly)

Question 22

Whilst assessing the thoracic spine/rib cage, what are you assessing?

Answer 22

• Does the thoracic spine adopt a kyphotic curvature? • Any indication of scoliosis? • Upper cross syndrome? • Any indication of a rotation or translation • Hyper/hypotonicity of the muscles of the thorax • Alterations in the development of the thoracic cage due to respiratory issues (COPD, asthmatic etc) • Angle of Louis/ manubriosternal junction

Question 23

Whilst visually assessing the musculature what are you looking for?

Answer 23

• Any indication of hypertrophy/atrophy • (May be due to neurological deficit/palsy, postural adaptation, ergonomics, sports) • Asymmetry between the left and right side • Muscular imbalance due to postural adaptations • Muscular imbalance due to joints being inhibited through the full ROM (structural/psychological apprehension)