PI Flashcards
Two Purposes of Motion Palpation?
1- Confirm instrumentation findings
2- Verify an x-ray listing
Three Uses for Motion Palpation?
Determine:
1- Which segment is subluxated
2- Listing of the subluxated segment
3- Effectiveness of the adjustment
Listing Body Rotation
1- Look at spinous rotation
2- Look at size of pedicles (wider= posterior rotation; narrower= anterior rotation)
3- Look at width of articular process (width is less on side of spinous rotation)
IN Characteristics (8)
1- Wider innominate 2- Narrower horizontal obturator foramen 3- HYPOlordosis of the lumbar spine 4- Raises femur head 5- Anterior SI joint opened 6- External foot rotation 7- Gluteal fold will be wide and flat 8- Wear on lateral heel and medial sole
EX Characteristics (8)
1- Narrower innominate 2- Wider horizontal obturator foramen 3- HYPERlordosis of the lumbar spine 4- Lowers femur head 5- Posterior SI joint opened 6- Internal foot rotation 7- Gluteal fold is narrow and peaked 8- Wear on medial heel and lateral sole
AS Characteristics (8)
1- Shorter innominate 2- Smaller vertical obturator foramen 3- HYPOlordosis of the lumbar spine 4- Raises femur head 5- Spongy edema at the posterior inferior SI joint 6- Sacrum posterior on the involved side 7- Leg will be longer 8- Gluteal fold will be higher
PI Characteristics (8)
1- Longer innominate 2- Longer vertical obturator foramen 3- HYPERlordosis of the lumbar spine 4- Lower femur head 5- Spongy edema at the posterior superior SI joint 6- Sacrum anterior on the involved side 7- Leg will be shorter 8- Gluteal fold will be lower
5 Components of the Gonstead system?
1- Symptomatology 2- Visualization 3- Static/motion palpation 4- Instrumentation 5- X-ray
Toe Out Foot Flare:
Unilateral- IN ilium or a PEX tibia (posterior rotation on side of external wedge)
Bilateral- Base posterior sacrum, knee problem, heavier kids (may outgrow it)
*wear on outside of heel
Toe In Foot Flare:
Unilateral- EX ilium, anterior talus (from inversion sprain), paralysis of extensor muscles
Bilateral- Posterior S2 tubercle, accompanied by hyperlordosis, pigeon toed, seen in children who walk too early
Antalgic Position:
(Cannot stand up straight)
- Check lumbars
- May have BP sacrum
Dishing:
Flatness in the thoracics is an anterior compensation for a posterior vertebra below
Components of Visualization (11)?
1- Head tilt/rotation 2- High shoulder 3- Low shoulder 4- Rib humping 5- Dishing 6- Loss of smooth lateral thoracic arc (stacking) 7- Scoliosis 8- Pelvic tilt 9- Buttocks/gluteals (wide/flat, narrow/peaked) 10- Foot flare 11- Antalgic position
Loss of Smooth Lateral Thoracic Curve:
Check spine by laterally flexing patient, look for loss of smooth arc
Bilateral loss- posteriority is the major component, stacking apparent
Unilateral loss- wedge part of listing on affected side is a major contributor; scoliosis will make lateral wedging harder to observe
Head Tilt/Rotation:
Head tilt is more common than rotation
Tilt- posteriorly rotated atlas will cause the head to be RAISED on that side due to shape of the superior articular facets (higher mastoid on that side)
Rotation- may be caused by overall spinal rotation or upper cervical rotation
AS Occiput:
In children, head tipped anteriorly and walks on toes
Bang heads to decrease pressure, resulting in a flattened forehead
Pelvic tilt: lower PSIS/gluteal fold, higher iliac crest
PI ilium, an anatomically short leg, or fallen arch
Pelvic tilt: higher PSIS/gluteal fold, lower iliac crest
AS ilium
Buttocks/Gluteals:
Flat: IN ilium or posterior rotated sacrum
Narrow/peaked: EX ilium or sacrum rotated posterior on opposite side
Rib Humping:
Ribs more prominent posteriorly on one side
High Shoulder:
1- Open wedge in mid thoracics on side of high shoulder
2- PS shoulder
3- Superior scapula
4- SC or AC subluxation
Shoulder Drop:
Paralysis of trapezius
Skin Changes (7):
1- Skin color (2) 2- Varicosities 3- Petechiae 4- Brown or white patches 5- Blemishes 6- Scarring 7- Hair changes
Skin Color–Redness:
In acute situations: 1- Rubbing 2- Increased vascularization 3- Swollen irritated tissue 4- Cutaneous radiation
Skin Color–Parasympathetic/red spot discoloration:
Small red spot usually seen in a parasympathetic dermatomal area (Occiput-C5 and below L5)
Caused by a chronic condition in which there is a change in the integrity of the neurological component of the tissue
Found in the upper cervical or sacral regions
Varicosities:
Chronic vascular changes in the sympathetic region, especially at VP and L5
When located at VP, may be accompanied by Dowager’s Hump (edema)
These follow a vasotome, focus on center of involved area
Petechiae:
Broken blood vessels (possible problem area)
Brown or White Patches:
Chronic neurological changes in the sympathetic area,
occur either left or right of spine because they are neurologically specific
Hair Changes:
Increased hair over sacrum and in abnormalities such as spina bifida
Decreased amount of hair over subluxation
Blemishes:
Possible problem area
Scarring:
Healing may be haphazard if nerve damage has occurred
Process of Subluxation:
1- Trauma/stress/chemical change misaligns the vertebra, shifting it into a sustained position
2- Nucleus compressed by vertebral body and exerts pressure on annulus
3- Annular fibers stretched beyond normal capacity and are torn/damaged
4- Inflammatory reaction fills disc with edema, causing disc to swell
5- Protrusion of the disc into neural canal of IVF compresses neural structures, resulting in “Nerve Pressure”
6- Nerve pressure results in nerve dysfunction
What 3 things make a true subluxation?
1- Edema
2- Fixation
3- Nerve impingement/pressure
Purposes of the dual probed instrument (4)?
1- Exact location of the subluxation
2- Intensity of nerve pressure
3- Patient progress
4- When subluxation is corrected
What is a subluxation from C2-L5?
Disorder of the disc
Whats is a subluxation in the upper cervical and SI regions?
Result of damages to interarticular ligaments (swell and produce nerve pressure)
Errors in Instrumentation (10)?
1- Gliding too fast
2- Varying glide speed
3- Uneven pressure of thermocouples
4- Too light of pressure on skin
5- Too wide a convergence of terminals in cervicals, causing air leaks
6- Not keeping terminals centered along spine
7- Not repeating the glide to bring out deflection and reduce ambient temperature
8- Not marking break at its peak
9- Marking the recession instead of the peak of the break
10- Misinterpreting skin lesions as subluxation deflections
Relation of a break to the involved vertebra, nerve, and disc?
Atlas/ Occiput- both readings are very close together, just below occiput
C2-T3- interspinous space below
T4- level of spinous
T5-T9- interspinous space above
T10-T12- level with the spinous
L1- L5- lower 1/4 of spinous
SI joint- anywhere between superior and inferior border of articulations
Components of Static Palpation (8)?
1- Contour changes 2- Spongy edema 3- Pitting edema 4- Tone 5- Texture 6- Temperature 7- Tenderness 8- High TVP
Contour Changes:
Look for when it takes place over 1-2 segments, compare side to side, increase pressure only after you pinpoint an area of change
Spongy Edema:
Occurs where nerve exits the spine except L5 where it my be farther out because of wide transverse of L5
Covers larger area than pitting edema
Found laterally, and also in thoracics under spinouses, and center of sacrum
Bilateral- transitional areas like VP and T12
Move edema ahead of finger and it should disperse with pressure
Center will be most sensitive and may cause symptoms in problem area
Pitting Edema:
Collagen breakdown of skin due to chronic inadequate nerve supply (chronic problem)
Seen in paraspinal muscles in T and L regions and usually unilateral
Bilateral- may be muscle insertion especially if T5 (rhomboid) or T12 (trapezius)
Tone:
Tissue fullness and active resistance
May be a change in cell turgor
As it becomes chronic it can lead to pitting edema
Texture:
Problem area will be smoother, silky due to suderiferous changes
Compare both sides of the spine– unilateral changes are significant
Will be sticky over the spinous process
What is the most sensitive part of the hand?
Thenar
Temperature:
Use whole hand to compare both sides of spine
Unilateral change= possible problem area
Thoracics may feel warmer near heart
High TVP:
Indicates side of body rotation
Tenderness:
Pain when pushing spinous toward the side of laterality
Tight/taut fibers- possible compensation
Tender/edematous/lax- subluxation
Errors in Motion Palpation (3)?
1- Too much force– be light!
2- The patient helps too much
3- Feeling the gross motion instead of individual movement
What causes fixation (3)?
1- Displacement of nucleus from central position
2- Edema, from damaged tissues drawing fluid into area
3- Adhesions that develop with chronic subluxation
Base Posterior Sacrum:
Vertebral arch of L5 intact
Bodies of the above vertebra are still in line
L5 disc wedged posteriorly or is parallel
What are the Stages of Disc Degeneration?
D1- Swollen disc (up to 6 months)
D2- Disc thin at posterior (2-5 years)
D3- Disc very thin at posterior (8-10 years)
D4- Total disc is thin (2/3 original height, 10-15 years)
D5- Total disc very thin (1/3 original height)
D6- Total disc extremely thin (15 years)
Gonstead methodology revolves around what?
Intervertebral disc