Test 2 Lecture Flashcards
Describe central sensitization in response to a chronic peripheral nociceptor site.
When an afferent stimulus bombards the spinal cord over an extended period of time, then the spinal cord becomes hyper excitable or sensitized.
In this sensitized state, a weaker afferent stimulus can excite both somatic and visceral efferents. Once established normal CNS activity can maintain it.
Describe how facilitation can lead to somatic dysfunction in a patient that strains a muscle
Strained muscle leads to a continuous sensory input and interneuron sensitization. Muscle becomes tense and restricts range of motion and it becomes tender to palpation. Prolonged tension continues the sensitization process. nociceptor activation releases chemicals and molecules in neighboring areas causing local vasodilation and tissue texture change. Finally muscle spasm, tension, exaggerated motor outputs can cause asymmetry (vertebrae for example can rotate and side bend).
How are champions points related to the discussion of somatic dysfunction as it relates to facilitation of the spine?
Chapmans points are associated with visceral dysfunction and are used for diagnosis. They represent the somatic manifestation of a visceral dysfunction. These are the gangliform contractions or tapioca pearls; smooth, firm, discretely palpable nodules located in the deep fascia or periosteum of bone. Pressure on these points will elicit sharp, non radiating, exquisitely distressing pain.
When you press into someones muscle, usually a taut band of muscle or fascia, and they feel radiating pain; what do you call it.
These are trigger points.
Tenderpoints do NOT radiate pain, trigger points DO.
what’s another name for viscero-viscero reflexes?
cross-organ sensitization
What are the 3 characteristics of a facilitated viscera-somatic reflex?
1 Persist beyond the time course of the originating stimulus
2 Produces effects disproportionate to stimulus intensity
3 Results in chronic changes in normal physiology of somatic structures induced by a subclinical visceral lesion
How does OMT disrupt the cycle of somatic dysfunction and neural reflexes?
Reduce peripheral tenderness
Reduce the hyper sympathetic drive
Augment lymphatic removal
Speed recovery
What are the attachments to ribs 1,2,3-5,6-9,10-11, 12
1 anterior and middle scaling 2 posterior scaling 3-5 pec minor 6-9 serratus anterior 10-11 latissimus dorsi 12 quadradus lumborum
What are some of the symptoms of costochondritis?
Multiple tender areas at articulations costosternal and costochondral junctions- No signs of acute injury: i.e. warm swollen
What are the 5 osteopathic models for patient treatment ?
Biomechanical Respiratory-Circulator Neurologic Metabolic energy Behavioral
How can you know if the pain a patient is feeling post mastectomy isn’t a cancer reoccurrence?
Pain is not typical of post mastectomy
concern with progressive pain
PE and ask details about the pain
As a baby was passing through the birth canal it twisted its thoracic diaphragm which would most likely lead to the following somatic dysfunction?
- torticollis
- plagiocephaly
- respiratiory irregularities
- lymphatic obstruction
- respiratory irregularities, irritability, and hiccups
You see a newborn with its head rotated away and side bent toward a hypertonic SCM. This disfunction is characterized by possible impingement of a nerve best treated by which procedure?
- OA decompression
- ME SCM
- Pedal pump
- Thoracic inlet release
OA decompression as CN XI is affected from possible compression at the occiput. This is torticollis
Which cranial bone is most susceptible to somatic dysfunction from the birthing process?
occiput
you notice a newborn with loss of naso-labial fold and facial paralysis. Cranial exam reveals nystagmus. The nerve affected attaches to which eye muscle?
lateral rectus CN VI
At birth the temporal and sphenoidal bones are arranged in what named segments?
Temporal- PMS petrosal, mastoid, squamous
Sphenoidal- Body with lesser wings, 2 greater wings, and pterygoid process
How are the occiput, parietal bone and frontal bone divided at birth
occiput- base, squama and two lateral parts
parietal- normal
frontal-two parts divided by metopic suture
The parallelograming of the temporal bone can cause external and internal rotation of the bone leading to what corresponding mastoid positions?
Internal rotation of temporal bone- more prominent mastoid moved anterolateral
External rotation of temporal bone-less prominent mastoid moved posteriomedialy
72.8% if newborns with cranial deformity, long labor, and birthing trauma have what problems in latter life?
learning difficulties
How do strain pattern correlate to learning difficulties?
There is a wide range of strain pattern in children both with and without learning difficulties. It seems that before 2 yrs old these have a larger impact of development.
Parallelograming of the temporal bone commonly leads to what dysfunction other than respiratory? Which nerves are affected?
Eye movement and position CN 346
Radicular pain maybe accompanied by what other findings?
numbness and tingling, diminished DTR, muscle weakness
Non radicular pain would be described how?
general pain or locational, or referred from a distant source
Red Flags for acute and chronic lower back pain?
acute- epidural absess, osteomyelitis, cancer, disk herniation or fracture, AAA, caudal equina syndrome
chronic-cancer, osteomyelitis, AAA, and lumbar stenosis
What are some clinical manifestations of a cancer patient?
Night pain or pain at rest, 50 y/o unexplained weight loss, failure to improve with therapy
Signs of caudal equina syndrome?
perianal numbness or saddle anesthesia
incontinence
decreased anal sphincter tone
lower extremity weakness
Name two symptoms of a herniated disk other than pain?
Severe muscle weakness, foot drop
What are some risk factors for vertebral fracture?
Corticosteroid injections, trauma, age, osteoporosis
What are the signs of disk herniation at L1-2, L2-4, L4-5 and L5-S1?
L1-2: pain anterior thigh w/o radiation below the knee
L3-4: same as above + anterior tibias muscle weakness and shin numbness
L4-5: Weak extensor hallucis longus
Numb top of foot
pain posterio-lateral thigh
L5-S1: calf weakness, no tip toe, asymmetrical achilles reflex
The conus modulars ends at which spinal level?
L1-L2
Compression of the nerve roots in cauda equina syndrome what type of muscle dysfunction?
paralysis w/o spasticity
Which nerve roots are most vulnerable to compression in caudal equina syndrome
S2-S4 which control bladder and anal function
What are some acute and chronic causes of caudal equina syndrome?
acute: trauma, disk herniation, abscess, hematoma
chronic: cancer
Your patient has muscle spasms that radiate to the groin, increased pain with just standing and walking, with a pelvic side shift test positive on the contralateral side of what problem?
Psoas syndrome
Unilateral shortening of the psoas muscle
Thomas test + ipsilateral
Pelvic side shift + contralateral
WTF is spondylolisthesis and lysis?
Spondylolisthesis is a forward displacement of one vertebra over another usual found at L5 over S1.
Lysis is when there is a separation of fracture of the pars interarticularis of the vertebral arch
What is the clinical presentation of spondylolisthesis and the 5 classification types?
Back pain with or without leg pain and tight hamstring
Painful extension
L5 nerve deficits
Type I Dysplastic: insufficient articulatory proces
Type II Isthmic: defect of pars interarticularis
Type III Degenerative: changes in the apophyseal joint
Type IV Traumatic: Fracture other than pars
Type V Pathologic: secondary to disease
What postural etiology is common for spondylolisthesis?
Hyperlordosis (gymnasts) which transfers weight from vertebral body to the articular facets
Your patient has just come home from active military duty in Iraq and complains of LBP. He is 20 y/o and looks like he’s been hitting the weight pretty good. If he has spondlylolisthesis what condition might this be secondary to?
Repetitive lumbosacral motion
Isthmic and dysplasic spondylolithesis increase someones risk of what?
Cauda equina syndrome
What are some high grade, conservative, and educational ways of tx spondylolithesis?
High grade-inject with steroids and if it works but the pain returns gradually surgical fusion is recommended
Conservative-anti-lordotic posture changes with brace
Ed: Proper movement, weight loss, flexion exercise only, stabilize and decrease lordosis.
TG is a 64 y/o patient c/o gradual onset of radicular pain bilateral in his LE, which have progressed proximal to distal. He feels relief by lying down or sitting. Sometime he leans forward in his chair which helps. PE reveals a positive rhomberg (proprioception). His condition would best be characterized by:
- narrowing of the lumbar spine
- movement of L5 anterior to S1
- fracture of the pars interarticularis
- moving like Jagger
- narrowing of the lumbar spine as this is lumbar stenosis
A facilitated segment in the spine can excite what nerve types with even a normal afferent stimulus?
somatic and visceral efferents
How would you use the respiratory-circulatory model of osteopathy to treat a woman having trouble with lactation?
Treat diaphragms of the body
Abdominal diaphragm
Thoracic inlet
occiput
Tx ribs and sternal fascia
What complications are you concerned with post mastectomy for a woman?
lymphedema in the upper extremity; arm morbidity.
When tx a woman post mastectomy how should you organize a regimen for her?
less time per treatment but more frequent visits
In what way is newborn behavior like a ninja?
smooth motions, awareness, meditation/self comfort, blink to avoid light (keep night vision), but adapt to repeated stimulus with a diminished response, they become quiet when they hear a sound and turn toward the sound.
How do you perform a neuro exam on a child?
watch and observe spontaneous activity
response to light, suckling a swallowing, response to sounds, look at their eyes
Nerve entrapments can be treated by OMT cranial manipulation. Which are the most common?
Occipital condylar compression CN IX X XI XII
Facial nerve 7 forceps delivery (face trauma)
Eye and face CN 6
How might you reason your way through the need to treat a child with condylar decompression; how would you detect a compression of related nerve roots?
CN XII difficulty moving the tongue in suckling
X vomiting excessively
XI colic or torticollis
A newborn had some trauma to the sphenobasilar symphysis during birth. How might you expect this to manifest itself?
Respiratory difficulty as this trauma is related to restriction of the temporal bone.
Don’t forget that spinal segments attached to ribs can affect the diaphragms ability to go through normal range of motion.
What common pediatric conditions can OMT tx help with?
Recurrent ear infections
Developmental delay
Autism
Behavioral issues-temper tantrums, or night terrors
What are two pediatric maneuvers you can use to test the MSK system in children?
Ortoiani and Barlow maneuvers (hip abductors)
