Palpation And Motion Flashcards
Somatic dysfunction
Impaired/altered function of related components of the somatic (body framework) system
Somatic system
Skin, fascia, muscle, arthrodial, and related vascular, lymphatic, and neural elements
T.A.R.t
. Tissue texture abnormality
. positional Asymmetry
. Restriction of motion
. tenderness
Palpation
. Application of variable manual pressure to surface of body to determine shape, size, consistency, position, motility, and health of tissues beneath
. Cornerstone of effective diagnosis and treatment
What can be determined through palpation?
Location, severity, and relevance of T.A.R.t
What is determined in identifying T.A.R. t?
. Motion impediment or restriction
. Interrelationship of structure and function and if it is messed up
What touch receptors are used in palpation exam and where are they most numerous?
. Merkel’s disks and Meissner’s corpuscles
. Numerous in finger pads
Are heat receptors superficial or deep to touch receptors?
Deep
What does light palpation reveal?
. Findings in skin and subcutaneous tissue
. Skin temp., moisture, texture, and turgor
Resting tone
. Normal feel of a resting muscle
. Can be hyper/hypotonic, or atomic compared with normal resting tone
What does deeper palpation reveal?
. Bones and joints
. Bony landmarks that are origin/insertion for muscles
What causes lack of turgor in skin?
Presence of dehydration, aging, and certain metabolic conditions
What does increased sympathetic tone to skin cause?
. Localized inc. in sweating and dec. in skin elasticity
. Keeps skin tight
Skin drag reaction
. Sense of resistance to light traction applied to skin and related to degree of moisture and degree of sympathetic nervous system activity
. Reflects area of somatic dysfunction
. Also indicated congestion if skin stays red
Where are changes from skin drag most intense in thoracic spine?
Costo-transverse articulation
Skin rolling test
. Grasp pinch of skin between thumb and index over area of palpable tissue change
. Pull skin away and note degree of resistance
. Could by hyperalgesic but not painful
What is common location for edema?
Subcutaneous tissue
Viscerosomatic reflexes produce tissue texture abnormality in what part of body and what are the characteristics of the abnormalities?
. Subcutaneous tissue
. Puffy, boggy, and rubbery feel
Long muscles receive innervation from ______ while short, deep muscles receive innervation from ____
Multiple spinal segments (long), single segments (short)
Long spinal muscles are ___ to short muscles
Superficial
What are long spinal muscles involved in?
. Postural patterns and group curves
. Lack segmental specificity
What are short spinal muscles involved in?
Segmental movement/dysfunction
Best way to palpate muscle
. Palpate in direction perpendicular to the fibers
. Superficial muscle: side to side
. Deep (oblique): vertical/ up-down
Hypertonic muscles characteristics
. Feel ropy/stringy
. Lack of homogeneity
. Bogginess
Flaccidity and cause
. No muscle tone
. Caused by disruption of proper neuronal info to the muscle (nerve root compression
Increased muscle tone is a sign of ____
Anxiety, inc. sympathetic outflow, or facilitated neural reflexes
Rough skin
Bumpy irregular surface
Smooth skin
Surface free from irregularities, roughness, or projections
Soft skin
Smooth or fine to the touch w/o firmness
Boggy sub-Q
Quality of inc. fluid (wet sponge)
Doughy sub-Q
Soft, thick, pasty mass
Puffy sub-Q
Swell or seem to swell as w/ air or fluid
Flaccid muscle
Lacking firmness, soft and weak
Hypertonic muscle
. Condition of excessive tone of skeletal muscles
. Inc. resistance of muscle to passive stretching
Muscle ropiness
Cord-like or rope-like feel to muscle that has been chronically contracted
Muscle stringiness
Palpable tissue texture abnormality characterized by string-like Myofascial structures
Tendons
.Fibroelastic strands of CT
. Feel like taut band of tissue, tense and smooth, homogeneous
. Easy to palpate
Ligaments
. Tough fibrous band that connect bone to bone
. Difficult to palpate bc they lie deep
. Serious injuries to them cause joint laxity
CT/fascia
. CT that lines, divides, separates, and support internal organs, muscles, cavities
. Feels like butter melting as it releases
Bone and joint palpation
. Reveals motion restriction/ asymmetry
. May elicit tenderness partially bc of depth of palpation
. Tissue overlying bone can sometimes feel boggy
Acute somatic dysfunction
. Immediate/ short-term impairment or altered function of related components of somatic system
How is acute somatic dysfunction characterized in early dysfunction?
. Vasodilation, edema, tenderness, pain, and contraction
. Tenderness even to light touch(hyperalgesia)
. Muscle tends to be hypertonic and puffy
Acute inflammation characteristics
. Redness (rubor)
. Warmth (calor)
. Pain (dolor)
. Swelling (tumor)
Blush reaction
Tissue remains red after palpation from local vasoactive mediators and autonomic mechanisms
Chronic somatic dysfunction
. Impairment or altered function of related components of somatic system
How is chronic somatic dysfunction characterized?
. Tenderness, itching, fibrosis, paresthesias, contracture
. Tissue change less intense ( dry, slick, thin, cool)
. Significant motion restrictions
. Pigment changes
Active motion
Motion produced by patient
Passive motion
Motion produced by physician without patient effort
What does quantity and quality mean in regards to motion?
What is range of motion and how does motion feel
How is quantity of motion measured?
Inspection, goniometer, inclinometer, tape measure
How is quality of motion measured?
Palpation
Once tissue texture change is found what happens?
Motion testing is performed after screening
What is determined in motion testing?
. Quality and quantity of motion
. Direction, range, and characteristics of tissue motion
Terms to describe quality of motion
Smooth, ratcheting, rubbery
How is quantity of motion addressed in motion testing?
Taking joint or tissue trough all directions of motion
What objective information does muscle testing provide?
Type, severity, and etiology of dysfunction
What is palpation used for during OMT?
Localize corrective forces and monitor for improvement in tissue
Gross movement of spine
Movement of group of vertebra
Segmental spine movement
. Movement of specific vertebra
. Named for superior segment in relationship to inferior segment
(Motion of T3 named for motion in relation to T4)
Major motions of spine
Flexion/extension, sidebending, rotation
Minor motions of spine
Translation (front/back, side to side, motion along axis), compression (pushing together), distraction (pulling apart)
Appendicular motion
. Movement of extremity joints
. Named for movement in relation to its proximal bone
What motions does somatic dysfunction usually occur in appendicular skeleton?
In minor motions of joint
Osteopathic medical practice requires what components?
. Thorough history
. Thorough physical exam
. Reasoned diagnosis
. Logical treatment plan based on above
Osteopathic manipulative medicine
application of osteopathic philosophy, structural diagnosis, and use of osteopathic manipulative treatment in diagnosis and management of patient
Osteopathic manipulative treatment (OMT)
Therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and homeostasis that have been altered in somatic dysfunction
Functional spinal unit (vertebral unit)
2 adjacent vertebra plus their related neural, vascular, CT, and muscles
How to determine functional spinal unit’s orientation in space?
Based on theoretical point on ant. Sup. Surface of upper vertebral body of unit
(Twist to right the dot moves to the right)
Spinal segment
Division of the spinal cord containing a bilateral pair of nerve roots
What do palpation skills help with?
. Identifying landmarks for electrocardiogram
. Performing lumbar puncture
. Starting IV, central line, arterial blood gas
. Examine organs
. Localizing injured/inflamed areas
. Performing breast, testicular, or rectal exam
Order of examination in osteopathic patient
.standing structural exam screen
. Motion testing
. Screening palpation exam
. Detailed palpation exam based on above
Hypotonicity
Result from underuse or aberrant neuronal info
How many aspects of T.A.R.t do you need to diagnose somatic dysfunction?
2 aspects
Tissue texture abnormality
. Palpable change in tissues from skin to periarticular structures that accompanies somatic dysfunction
. Different for acute v. Chronic injuries
Acute tissue abnormalities
. Recent history . Severe pain . Warm, moist, red skin . Sympathetic: vasodilation of skin . Increased muscle tone . Edematous, puffy tissue . Moist skin . Minimal somatovisceral effect
Chronic tissue texture abnormalities
. Long standing . Dull, achy pain . Cool, pale skin . Sympathetic: vasoconstriction of peripheral vessels . Decreased tone, limited ROM . Doughy, stringy, ropy tissues . Pimples, scaly, dry, pigment change . Frequency somatovisceral effects
