Resp Final Flashcards
OMT is indicated for adults with SD related to…
URI (rhinitis, sinusitis, cold, Eustachian tube dysfunction), headache (cephalgia), temporomandibular joint dysfunction (TMJ), pharyngitis, cranial neuropathies, head trauma, vertigo, psych
OMT is indicated for kids with SD related to…
NAS Difficulty latching Plagiocephaly Otitis media URI Head Trauma
Symptoms of sinusitis
Headache/facial pain
Runny nose
Nasal congestion
Fever
Causes of sinusitis
Viral
Bacterial
Fungal
What decreases the body’s immune response regarding anatomy of sinusitis?
Tissue swelling
Impaired blood flow
Impaired lymphatic drainage
Increased sympathetic tone from upper thoracics can cause ___________ and thicken mucus as well as _________ lymphatic flow and response.
Vasoconstriction; decreasing
__________ parasympathetic tone can cause tearing and runny nose.
Increased
Dysfunction of the upper cervical/suboccipital areas can cause irritation of the _____ nerve
Vagus
Cranial dysfunction can affect the ______ of the sinuses as well as ____________ to the head
Drainage; parasympathetics
Goals for treatment of URI
Improve drainage
Treat offending organism
Support patient
What are the 5 models of osteopathic care?
- Respiratory-circulatory
- Neurological
- Biomechanical
- Metabolic-energy
- Behavior
What can facial effleurage be used for?
Promote lymphatic drainage from the head (resp-circ model)
Neurological model with URI
Trigeminal stimulation, sphenopalatine ganglion stimulation
Primary headaches
- Migraine headache
- tension-type headache
- trigeminal autonomic cephalgias (cluster)
Secondary headaches
Due to another pathology/injury
Red flags
- First and/or worst headache of the patient’s life
- Headache beginning after 50 years of age or before 5 years of age
- Occipital headaches in children
- Headache with signs of systemic illness (fever, stiff neck, rash)
- Abnormal neurologic exam
- Headache subsequent to head trauma
- Headache associated with alteration in or loss of consciousness
- Headache triggered by exertion, sexual activity, or Valsalva maneuver
- New or severe hypertension
- New headache in patients with cancer, immunosuppression, pregnancy
- Different than the normal pattern
Migraine headaches
- Side: unilateral (usually frontotemporal)
- Character: pulsating
- Intensity: moderate to severe
- Duration: 4-72 hours
- Triggers: maybe
- Associated symptoms: nausea/vomiting and/or photophobia/phonophobia; may have auras or prodromes
Tension-type
- Side: bilateral
- Character: tightening/pressure
- Intensity: mild to moderate
- Duration: 30 minutes to 1 week
- Triggers: anxiety, stress, depression, poor posture
- Associated symptoms: may have photophobia or phonophobia, but not both
Cluster
- Side: strictly unilateral, orbital, supraorbital and/or temporal
- Intensity: severe to very severe
- Duration: 15 minutes to 3 hours or longer
- Triggers: alcohol, histamine, or nitroglycerine during a cluster period
- Associated symptoms: occur in series or clusters; ipsilateral facial symptoms such as edema, congestion, lacrimation, sweating, miosis, and more; restless/agitated
TMJ
- Describes a number of clinical problems: clicking/grating within the joint, mechanical restrictions, jaw/ear/facial pain, headache, neck pain, and stiffness
- May be acute or chronic
- Most common non-dental cause facial pain
- It is believed that the etiology is likely multifactorial
TMJ joint itself…
- Synovial joint between condyle of mandible and mandibular fossa of temporal bone
- Fibrocartilaginous disc
- Complex motion - hinge, lateral glide, protraction, retraction
Symptoms of TMJ
- Chronic pain in the muscles of mastication described as a dull ache, typically unilateral
- Pain may radiate to the ear and jaw and is worsened with chewing
- Bruxism, teeth clenching
- Locking of the jaw or asymmetrical movement when attempting to open the mouth
- Clicking or popping, usually when displacement of the articular disk is present
- A bite that feels uncomfortable or different from usual
- Headache , neck, shoulder, and back pain
- Increasing pain over the course of the day
- History of jaw and/or facial trauma
Acute approach to treating TMJ
OMT
Stretching the joint capsule
NSAIDs if needed
Muscle relaxers if necessary
Chronic approach to TMJ
- more difficult
- best managed with team approach
OMT techniques for TMJ
- Suboccipital inhibition
- C1 treatment
- Temporalis MFR
- Masseter inhibition
- AC7 and AC8 counterstrain
Viscerosomatic reflexes SD in LRI
- T2-T7 facilitation
- OA dysfunction
- Chapman points: 3,4 anteromedial intercostal spaces and T3-4 transverse processes
Structural factors for SD in LRI
Rib restriction, segmental restriction, muscular restriction
Lymphatic factors for SD in LRI
Diaphragm tension, MF restriction
Acute SD
Hot, moist, edema, tense, prolonged red reflex, type II
Chronic SD
Cool, dry, thick, ropy, blanching, type I and II
Neurologic model for LRI
- Upper cervical treatment (parasympathetic normalization)
- Suboccipital inhibition
- OA myofascial release
- T2-7 treatment (sympathetic normalization and improves chest excursion)
- Soft tissue
- Rib raising
- Segmental myofascial release/ muscle energy
Suboccipital inhibition can be used to normalize _______ tone
Vagal
Biomechanical model for LRI
- Restoring proper rib and vertebral segment motion:
- Improves chest excursion
- Helps decrease muscle fatigue
- Helps to decrease the work of breathing
Respiratory/Circulatory model for LRI
- Lymphatic OMT improves breathing and immune response
- Diaphragm treatment improves breathing and lymphatic flow
- Thoracolumbar (TL) Diaphragm
- Cervicothoracic (CT) Diaphragm
- Sibson’s fascia
- Lymphatic pumps improve lymphatic and venous drainage
- Thoracic pump
- Pectoral traction
- Pedal pump
CT diaphragm tension limits drainage from _____ ______. _______ duct passes through it twice
Entire body; thoracic
TL diaphragm tension limits drainage from…
Abdomen, pelvis, LE
Thoracic pump is contraindicated with…
aspiration, pulmonary embolism, acute congestive heart failure, COPD (rebound)
_______ ________ is a gentler alternative to thoracic pump
Pectoral traction
Relative contraindications for OMT for LRI
-Pulmonary embolism
-Unstable congestive heart failure
-Unstable arrhythmia
Others
-Acute rib fracture
-Lung cancer
-Aspiration
-Chronic obstructive pulmonary disease (Noll 2008)
-Severe osteoporosis/elderly