Structural (Postural) Assessment Flashcards
Postural Homeostasis
– if imperfection, body seeks balance
o Compensation of posture based upon physiologic mechanisms between CNS integration of peripheral informationa
Observation
– gait, posture
o Symmetry vs. asymmetry
o Gain information on visible defects, functional defects, and abnormalities of alignment
o Determine whether these findings are related to the pathology being presented
Somatic Dysfunction
– impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements
o Objective diagnostic findings of somatic dysfunction are: ARTT
• ONE of these must be present for the diagnosis
Asymmetry
Restricted motion – primary finding for somatic dysfunction
Tissue texture changes – another primary finding for somatic dysfunction
Tenderness may be elicited on palpation but is a weak indicator of somatic dysfunction due to:
• Pain – may be present in one area but the primary dysfunction/problem be distant
Physiologic Spinal Curves
o Kyphosis – at birth; primary curve
Thoracic/sacral
Posterior convexity; anterior concavity
o Cervical Lordosis – develops as a result of cervical extensor muscles developing; head is raised
Posterior concavity; anterior convexity
o Lumbar Lordosis – develops as infant begins to crawl & walk
Posterior concavity; anterior convexity
Pregnancy increases
Transition vs. Cross-over Zones
o Transition zones – areas commonly susceptible to somatic dysfunction and biomechanical stress
Occipitocervical, cervicothoracic, thoracolumnar, lumbopelvic junctions
Includes arthrodial, skeletal, and myofascial anatomy
o Cross-overs – occur wherever the postural line crosses the gravitational line
Occur at transition zones
Foot Pronation vs. Supination
Foot Pronation – excessive weight/shift medially
Foot Supination – excessive weight/shift laterally
Spinal Dysraphism
– incomplete fusion or malformation of bone and neural structures of the spine regions by errors in the closure of the neural tube during the 4th week of embryogenesis
• Most common abnormality occurs at L5-S1 junction
• Ex: spina bifida occulta, spinal meningocele, myelomeningocele
• Associated conditions: myelomeningocele, hydrocephalus, diastematomyelia, tethered spinal cord, spinal lipoma, syringomyelia
• Cutaneous manifestations: port-wine stain, hemangioma, hypertrichosis (excessive, abnormal hair pattern), dimple (L/S junction; sacrum), lipoma, pigmented nevus, dermal sinus (simple above gluteal crease)
Scoliosis
-asymmetry of spine; also affects scapula
Winging of Scapula
– difference in spacing from the midline
• Causes: trauma, iatrogenic (induced by mistake by a physician or medical treatment), or idiopathic that results in nerve injury and paralysis of either serratus anterior (long thoracic nerve), trapezius (spinal accessory nerve), or rhomboid muscles (dorsal scapular nerve)
• Diagnosis: medial winging of scapula – caused by serratus anterior weakness/paralysis
o Lateral Winging of Scapula – caused by trapezius and rhomboid weakness/paralysis
Pes planus vs. pes cavus
Pes Planus – flat foot
Pes Cavus – high arch; supination
Genu Recurvatum – knees look like they’re popping out posteriorly
• Hips anterior to tibia/patella
genu valgum vs. genu varus vs. genu recurvatum
Genu varum – varus knees; knees point laterally outward
• “bow legged”
Genu Valgum – valgus knees; knees point medially inward
• “knock-kneed”
pectus excavatum vs. pectus carinatum
Pectus Carinatum – protrusion outward in center of chest
• “Pigeon breast”
• Question: A 42 year old car mechanic presents to your office complaining of pain on the right side of his lumbar spine. On static examination you observe the following: his thoraco-lumbar spine is forward and side-bent to the right and he has difficulty standing upright/erect. Which of the following is the one possible etiology of this patient’s posture?
a) Spasm of the right psoas major muscle
