review Flashcards
What are the 4 osteopathic tenets
- a person is product of interactions between mind, body, and spirit.
- individuals are capable of self healing
- structure and function are reciprocally interrelated
- rational treatment is based on these principles`
What are the important dates in osteopathy
- Born August 8, 1829
- Unfurled june 22, 1874
- Osteopathy coined in 1889
- First school at Kirksville in 1892
The 5 Tenets of the Primary Respiratory Mechanism
- The fluctuation of the CSF and the potency of the tide
- The mobility of the intracranial and intraspinal membranes, and the function of the reciprocal tension membrane
- The inherent motility of the central nervous system
- The articular mobility of the cranial bones
- The involuntary mobility of the sacrum between the ilia
Tenet 1
Movement of the CSF involves circulation and fluctuation
70% of CSF is formed at the choroid plexi in the ventricles
30% of CSF is formed as CSF extracellular fluid moves into the subarachnoid space.
The intraventricular and subarachnoid spaces are connected by the foramen of Magendie and the foramen of Luschka
CSF is drained by the paravascular and extracellular spaces of the CNS
Cranial Rhythmic Impulse (CRI)
Fluctuation of the CSF has 2 characteristics:
- Physical potency/energy that acts throughout the body as a hydrodynamic mechanism
- Electrical potential acting in positive and negative phases
Both are intimately integrated with the reciprocating motility of the CNS
Occur at 10-14* cycles per minute in normal adults
Tenet 2
“three sickle-shaped agencies, all of which arise from a common origin at the straight sinus, named “The Sutherland Fulcrum” in honor of its discoverer, and have their secondary insertion into the various bones of the cranium.”
Attachments of falx cerebri
Crista galli of the ethmoid Frontal bones along the metopic suture Parietal bones along the sagittal suture Occiput Tentorium cerebelli
Attachments of the tentorium cerebelli
Posterior clinoid processes of the sphenoid Petrous ridges Mastoid portion of the temporals Posteroinferior angles of the parietals Transverse ridges of the occiput
Attachments of the falx cerebelli
Tentorium cerebelli
Occiput to foramen magnum
Inhalation phase (flexion of SBS, external rotation of paired bones):
- Falx cerebri shifts anteriorly in the arc of its sickle
- Crista galli moves posteriorly
- Tentorium cerebelli shifts anteriorly and flattens, but is not relaxed
- Venous sinuses change in shape from “V” to ovoid with increased capacity for drainage of blood. They do not contain muscle within the walls to enhance the return of blood into circulation
- Midline bones move into flexion
- Paired bones move into external rotation
- Cephalad pull on spinal dura causes sacral base to move posterosuperiorly while the apex moves toward the pubic symphysis
Exhalation phase (extension of SBS, internal rotation of paired bones):
- Falx cerebri shifts posteriorly in the arc of its sickle
- Crista galli moves anteriorly
- Tentorium cerebelli shifts posteriorly and rises
- Venous sinuses change in shape from ovoid to “V” with decreased capacity for drainage of blood.
- Midline bones move into extension
- Paired bones move into internal rotation
- Caudad pull on spinal dura causes sacral base to move anteroinferiorly while the apex moves away from the pubic symphysis
Tenet 3
The inherent motility of the central nervous system
Oligodendroglial cells pulsate in culture
Pulsatile CSF and brain motion is detectable on MR imaging
MRI techniques needed to be developed to reduce the artifact caused by inherent motion
Physiologic brain motion lowers the mean metabolite concentrations on proton MR spectroscopy imaging
Tenet 4
The articular mobility of the cranial bones
Periostium of the inside of the skull splits into 2 layers at the suture and forms a fibrous capsule over the edge of the bone.
Fiber bundles and sinusoidal blood vessels are in the central zone of the sutures.
Periostium is also contiguous with the dura mater and falxes.
Movement in the sutures is NOT the same as other joints in the body. It is more of a resiliency of living, pliant bone.
There is small motion at the SBS which is amplified in the vault due to a vector arc.
Ossification of the Sphenoid
The first ossification centers begin in the 8-9th week in utero.
Much of the bone is pre-formed in cartilage.
At birth the bone and consists of a central part (body and lesser wings) and two lateral parts (each comprising a greater wing and pterygoid process).
By the twenty-fifth year, sphenoid and occipital bones are completely fused, and considered a symphysis. Prior to that, it is a synchondrosis
Ossification of the Occiput
Ossification of the occiput commences around the 7th week of fetal life.
At birth the occipital bone consists of four separate parts (a basilar part, two lateral parts and a squamous part, all joined by cartilage and forming a ring around the foramen magnum. The squamous and lateral parts fuse together from the second year.
The lateral parts fuse with the basilar part during years 3 and 4, but fusion may be delayed until the 7th year.
Fusion 5 years per DiGiovanna
Tenet 5
The involuntary mobility of the sacrum between the ilia.
Involuntary motion around a transverse axis at S2.
Respiratory motion occurs along a transverse axis in response to respiration. During inhalation, the lordotic curve decreases and the sacral base moves posteriorly. Exhalation increases the lordotic curve and the sacrum moves anteriorly.
L5 Rules
- L5 rotates opposite of sacrum.
- L5 sidebends toward the oblique axis.
- The oblique axis is opposite the side of the positive seated flexion test.
Anterior lumbar tender point locations
L1 - medial to ASIS L2 - medial to AIIS L3 - lateral to AIIS L4 - inferior to AIIS L5 - anterior aspect of pubic symphysis
Patient is supine, with hips and knees flexed, rotated and sidebent
Posterior lumbar tender point locations (PL1-5)
Spinous processes centrally and posterior transverse processes.
Patient is prone, extended, rotated and sidebent away from tender point.
Seated lumbar HVLA “Walk Around” technique for type II dysfunctions
Diagnosis: L2FRSR
- Heel of right hand over right TP L2
- Have patient salute with left and grab their right humerus
- Have patient slump forward and drop their elbows
- Extend patient until motion palpated at L2, then SIDEBEND the patient to the LEFT BY TRANSLATING THEIR SHOULDERS TO THE RIGHT
- Rotate patient left by pulling on right humerus and adding ant pressure with heel of right hand
- Final corrective force is a quick, ant and laterally directed thrust to the right transverse process from the right hand.
