PART II Flashcards
What is the purpose of static palpation?
facilitate the analysis of soft or bony tissue
structures within the body.
Define turgidity
Intrinsic pressure or resistance offered by a cell or tissue.
What is the direction which you apply pressure in the palpatory tenderness part of deep touch?
I-S, P-A on spinous followed by bilateral L-M pressure on spinous.
Define sclerotogenous
Pertaining to
ligament, tendon insertion on bone,
disc, periosteal, or zygapophyseal
structures.
On the nervoscope (for our purposes) what setting should the sensitivity switch be set to?
Low or medium
T/F
A swing is usually found at one segment
False, swings are usually multisegmental
How long does acclimation take?
10 minutes, ideally
What is the ideal glide time for scoping the cervicals?
18-21 seconds (3 sec/segment)
Where are confirmed breaks marked in the cervicals?
1/4” below mid thermocouple well outside of the glide path
Instrument pitch must always be in accordance with…
Disc plane line/skin surface
What is the glide speed for thoracolumbar scope?
35-38 seconds (2 seconds/segment)
When scoping how do stay in the proper glide path if there are lateral curvatures?
Follow the lateral curvatures keeping spinouses in the middle.
Where are confirmed breaks marked in the thoracolumbar region?
1/2” above mid thermocouple, well outside of the glide path.
Instrumentation tells us where to adjust, when to adjust, or both?
When
What is the break location for occiput - C1?
Suboccipital - between the two segments
What is the break location for C2-T3
Interspinous space below
What is the break location for T4
It’s own spinous level
What is the break location for T5-T9
Interspinous space above
What is the the break location for T10-T12
At it’s own spinous level
What is the break location for L1-L5?
Lower 25% of involved segment
When recording a positive instrumentation finding, how do you document it?
Segment involved, direction, amplitude (increments of deflection). E.g. T3/R/4
List the 8 steps for assessment of the VSC and adjustment.
History/symptomatology Visualization: posture/leg check Instrumentation Static/motion palpation Spinography Vertebral subluxation complex Adjust with the appropriate technique Lifestyle education (4 T's).
What aspect of the PART system does instrumentation satisfy?
Tissue/tone
What are some epidermal conditions that can reduce the reliability of instrumentation findings?
- Burn / Sunburn
- Blemish / Acne
- Infection
- Fever
- Perspiration (IR scatter)
What are some physiologic variabilities that can reduce the reliability of instrumentation findings?
Dermatomes / Neuropathies
What is instrumentation assessing?
Vasomotor function as a reflection of aberrant
neuromodulaton (gathering information in the dermal
microvasculature)
The Tytron C-3000 gathers information from what aspect of the epidermis?
The first 5 mm into the epidermis
T/F
The sympathetic nervous system functions as the result of an antagonist
False,
functions without antagonist
Cold receptors are myelinated, which means that the conduction is what?
Saltatory
Ambient control is specific to what?
Dermatomes
The signal enters the cord where?
The dorsal horn at the tract of Lissauer
The tract of Lissauer sorts between what?
Pain and temperature
After synapsing in the dorsal horn, where is the next synapse?
From gray matter to white matter to become the Lateral spinothalamic tract
Where does the LST synapse after entering the brain
VPL of thalamus
The thalamus then synapses where?
Broddman area 3,1,2, Insular cortex (insula/"isle of Reil")
What does the anterior portion of the insular cortex regulate?
Viscero-autonomic function
The insula then forwards the message to what structure?
The hypothalamus (specifically the adenohypophysis, which regulates autonomic function).
The anterior hypothalamic nucleus (adenohypophysis) then becomes what?
A descending autonomic tract
Where does the DAT travel?
Passes through the brainstem and travels to the site of original dermatomal thermoregulation (preganglionic sympathetic fiber).
What does the preganglionic sympathetic fiber synapse with?
The sympathetic paravertebral ganglionic chain
After synapsing with the sympathetic paravertebral CG, what are the 3 possible outcomes of the preganglionic sympathetic fiber?
Ascend to ganglion at higher cord level
Descend to ganglion at lower cord level
Stay at the same ganglionic level
PSF will neurotransmit AcH and stimulate which kind of Post ganglionic sympathetic fiber?
Nicotinic
The postganglionic fiber in this pathway will release what?
Epinephrine
The terminal point of the pathway is where?
Tunica media for vasoconstriction.
What does it mean that the thermoregulatory pathway is “unapposed”?
No antagonist
Since the sympathetic nervous system is represented by cord levels T1-L2, how does the cervical spine receive sympathetic info?
Sympathetic chain extending upward
What does the ascending sympathetic chain represent? What principle does it support?
Represents core activity below. Supports pattern analysis
The Tytron C-3000 is primarily used for which kind of analysis?
Pattern analysis
T/F
The Tytron C-3000 can’t be used for break analysis
False,
It isn’t usually, but it can be.
What kind of chiropractic utilizes the Tytron C-3000 morso?
Upper cervical techniques (primarily as a periodic evaluation tool)
T/F
The Tytron C-3000 is a great tool, but it’s not very reproducable.
False
The Tytron C-3000 is insightful about which parts of the VSC?
Neuropathology (dermal thermoregulation)
Histopathology (to a smaller sense)
Cytological / Inflammation / Edema
The Tytron C-3000 is insightful about which aspect of the PART system?
Tissue/tone changes
T/F
Patient placement is identical to
that of running a cervical glide
with a Nervoscope.
True
Where does the Tytron scan start and finish?
Commences at S2 and terminates at the base of occiput
The Tytron scan should be conducted at a smooth and continuous speed of…
1 sec/segment
T/F
When you do a Tytron scan, you only do a mastoid fossa reading when your results from the full spine scan are ambiguous.
False,
You ALWAYS do a mastoid fossa reading.
What information does the mastoid fossa reading provide?
More specific information about the upper cervical complex (BUT MOST SPECIFICALLY C2)
What is the protcol for a mastoid fossa reading?
Pressy “F” key
Right barrel in right fossa
Right barrel in left fossa.
0.5 degrees C is clinically significant
Pattern analysis is a system of analysis that takes what into consideration?
that thermal shifts on the surface of the skin occur as a part of normal physiology.
What is the assumption made if the thermal shifts associated with normal physiology aren’t there?
it can be correlated with autonomic dysfunction
and compromised ability to adapt.
What is the gold standard in pattern analysis?
3 thermal readings (scans) over a 24
hour period with the scans spaced
apart as evenly as possible.
What information does the gold stand in pattern analysis tell the doctor?
This allows the doctor the
opportunity to see how the body
can / can’t adapt over time.
If pattern analysis is apart of your assessment of a patient, what role does the scans upon subsequent visits play in relation to the adjustment?
Subsequent scans are compared to the original scan (pattern) and determines whether an adjustment is appropriate.
What are the 3 general scan types?
Pattern
Adaptive
Stress
What are the causes of a stress scan (4)
Emotional stress
Physical stress / Pain
Drugs
Caffeine
What does the second component of the occiput listing (RS/LS) account for?
The coupled misalignment of laterality and superiority
What does the final component of the occiput listing (RP/RA) account for?
Rotation on the side of laterality
AS or AI listing tells us about the misalignment of what?
Anterior tubercle of atlas either superior or inferior
What does the second part of the atlas listing (R or L) account for?
Laterality only
What does the final component of the atlas listing (A or P) account for?
Rotation on the side of laterality
T/F
Motion palpation is reliable as a stand alone tool in assessing for a VSC?
False
Without other indicators, plus a good protocol and experience, it’s weak.
Motion palpation is insightful about which parts of the VSC?
Kinesiopathology (relative position, global ROM
Intersegmental fixation)
Motion palpation is insightful about which aspects of the PART system?
P – Pain and Tenderness
A – Asymmetry / Misalignment
R – Range of Motion
What is a listing system derived from?
Spinographic analysis
T/F
Motion palpation qualifies the actual misalignment
found on x-ray
True
The listing system gives what information about the adjustment?
Information in choosing the appropriate technique
T/F
A listing system fosters reproducibility
True
3 considerations of a listing system
Anatomical variability (Important to have a reproducible analysis)
Static picture of a dynamic entity (important to re-evaluate, proper positioning - neutral)
Protocol is a frame of reference
(Acute patient?)
Spinous laterality intrinsically accounts for what else?
Body rotation
What is the hallmark of the Palmer/Gonstead system considering our purposes?
Compare to the segment below
What is the hallmark of the Palmer upper cervical specific system, considering our purposes?
Compare to foramen magnum
Which listing system are we concerning with?
Palmer/Gonstead system
In what conditions will you see a global wedge?
Scoliosis
Lateral curvature
T/F
You won’t notice any lateral curvature with a segmental wedge
True,
A segmental wedge is stand alone
T/F
You can obtain a PS/AS occiput misalignment from APOM view?
False,
Only wedging and rotation
What is compared in C2 spinous laterality?
The distance of the C2 laminar junction to its own
superior lateral border
What are the 6 rationale for taking x-rays emphasised in class
- Pain or neurologic symptoms
- Spinal trauma (Falls, Sclerotogenous pain, Fractures, etc..)
- Alignment abnormalities / Abnormal curvatures / Scoliosis (Cobb Angles)
- Arthropathy
- Spine instability or limitation of motion
- Osteoporosis
How is posteriority determined on lateral thoracic/lumbar x-rays?
Visualization
What are the other heuristic devices compared with the elusive/abstract nature of subluxation according to the subluxation article (4)?
Genes, gravity, ego, life.
T/F
According to the article, chiropractic is based on the theory of subluxations.
False,
Based on the success of the chiropractic adjustment.
“The empirical or clinical success came first, the
theory attempting to explain the success of the adjustment such as nerve impingement, dis-ease, subluxations and others followed.”
For the two alternate thoracic lateral bend and rotation, what segments may be contacted?
T1-T3
In performing a P-A lumbar extension, what are you assessing for?
“Joint excursion”
In performing a P-A lumbar extension, the spinous of the involved segment will not glide through normal motion or in other words…
Will have loss of resilience at end play.
Which of the three Tytron scans is represented by just a yellow line?
Stress scan
When doing a Tytron scan, what signals you are ready to start scanning?
Press trigger and wait for SECOND tone and the screen prompt to read: SCANNING
T/F
Hair sweep is not necessary for the Tytron scan
False,
Hair sweep (or head stabilization) “on the fly” as you go up into the UPPER THORACIC region.
When do you break contact at the termination of the Tytron scan?
After releasing the trigger.
T/F
Lift up the earlobe to perform the mastroid fossa reading and make contact with the skin for 2 seconds before releasing
False,
Barrels are NOT to touch the skin. Must hold for 3 seconds
What do you do when the fossa reading is done?
Press ESC twice and enter fossa value as your comment to save.
T/F
A significant fossa readin (0.5 C or greater) indicates laterality?
False,
There is no correlation to segment laterality
