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COMLEX - Savarese > Trigger Points (HY) > Flashcards

Trigger Points (HY) Flashcards

1
Q

What does TART stand for?

A

T-Tissue texture changes
A-Asymmetry
R-Restriction
T-Tenderness

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2
Q

What is the Physiologic Barrier?

A

Point at which a PATIENT can ACTIVELY move any given joint

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3
Q

What is the Anatomic barrier?

A

Point at which a PHYSICIAN can PASSIVELY move any given joint

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4
Q

Findings of ACUTE Tissue texture changes.

A
  • Edematous
  • Erythematous
  • Boggy w/ increase moisture
  • Hypertonic muscles
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5
Q

Findings of CHRONIC Tissue texture changes.

A
  • Cool dry skin w/ slight tension
  • Decreased muscle tone (flaccid)
  • Ropy
  • Fibrotic
  • NO edema (or decreased)
  • NO erythema
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6
Q

What are the findings of Asymmetry in Acute & Chronic conditions?

A

Acute - Present

Chronic - Present w/ COMPENSATION in other areas of body

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7
Q

Restriction findings in ACUTE condition.

A

Painful w/ movement

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8
Q

Restriction findings in CHRONIC condition.

A

Decreased or NO Pain

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9
Q

Tenderness findings in ACUTE condition.

A

Severe, Sharp

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10
Q

Tenderness findings in CHRONIC condition.

A

Dull, Achy, Burning

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11
Q

Orientation of Superior facets:

-Cervical

A

“BUM”

Backward
Upward
Medial

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12
Q

Orientation of Superior facets:

-Thoracic

A

“BUL”

Backward
Upward
Lateral

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13
Q

Orientation of Superior facets:

-Lumbar

A

“BM”

Backward
Medial

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14
Q

Flexion/Extension:

  • Axis:
  • Plane:
A

Flexion/Extension:

  • Axis: Transverse
  • Plane: Saggital
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15
Q

Rotation:

  • Axis:
  • Plane:
A

Rotation:

  • Axis: Vertical
  • Plane: Transverse
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16
Q

Sidebending:

  • Axis:
  • Plane:
A

Sidebending:

  • Axis: Anterior-Posterior
  • Plane: Coronal
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17
Q

Describe DIRECT treatment.

A

Towards barrier

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18
Q

Describe INDIRECT treatment.

A

Away from barrier

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19
Q

Describe ACTIVE treatment.

A

Patient assists during treatment

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20
Q

Describe PASSIVE treatment.

A

Patient RELAXES during treatment

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21
Q

OA:

  • Main motion
  • Sidebending & Rotation
A

OA:

  • Main motion: Flexion/Extension
  • Sidebending & Rotation: Opposite
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22
Q

AA (C1):

  • Main motion
  • Sidebending & Rotation
A

AA:

  • Main motion: Rotation
  • Sidebending & Rotation: Opposite
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23
Q

C2-C4:

  • Main motion
  • Sidebending & Rotation
A

C2-C4:

  • Main motion: Rotation
  • Sidebending & Rotation: Same
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24
Q

C5-C7:

  • Main motion
  • Sidebending & Rotation
A

C5-C7:

  • Main motion: Sidebending
  • Sidebending & Rotation: Same
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25
Q

What is the main motion of the Thoracic spine?

A

Rotation

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26
Q

True Ribs.

A
  • Ribs 1-7

- Attach to the sternum through costal cartilages

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27
Q

False Ribs.

A
  • Ribs 8-12

- Do NOT attach directly to the sternum

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28
Q

Floating Ribs.

A
  • Ribs 11-12

- Unattached anteriorly

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29
Q

Describe the attachment of Ribs 8-10.

A
  • Each are connected by its costal cartilage to the cartilage of the rib superior
  • Example: The costal cartilage of Rib 9 attaches to the costal cartilage of rib 8
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30
Q

What are the 3 types of rib movements?

A
  • Pump-handle
  • Bucket-handle
  • Caliper
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31
Q

Pump-Handle motion.

A

Ribs 1-5

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32
Q

Bucket-handle.

A

Ribs 6-10

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33
Q

Caliper motion.

A

Ribs 11-12

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34
Q

Describe Inhalation dysfunction.

A

Dysfunctional rib will move Cephalad during Inhalation, but will NOT move Caudad during Exhalation
-Rib will appear to be “Held Up”

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35
Q

Describe Exhalation dysfunction.

A

Dysfunction rib will move Caudad during Exhalation, but will NOT move Cephalad during Inspiration
-Rib will appear to be “Held Down”

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36
Q

Grouped Rib INHALATION dysfunction KEY RIB?

A

Lowest Rib of dysfunction

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37
Q

Grouped Rib EXHALATION dysfunction KEY RIB?

A

Uppermost Rib of dysfunction

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38
Q

Spina bifida occurs when there is a defect in what?

A

Closure of the Lamina of the vertebral segment

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39
Q

Where does Spina Bifida usually occur?

A

Lumbar spine

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40
Q

Spina Bifida Occulta.

A
  • No herniation through defect
  • Course patch of hair over site
  • Rarely associated with neurological deficits
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41
Q

Spina Bifida Meningocele.

A

-Herniation of the Meninges through the defect

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42
Q

Spina Bifida Meningomyelocele.

A
  • Herniation of the Meninges & Nerve roots through defect
  • Associated with neurological deficits
43
Q

What is the main motion of the lumbar spine?

A

Flexion/Extension

44
Q

A flexion contracture of the Iliopsoas m. is often associated with what type of dysfunction?

A

Nonneutral dysfunction at L1 or L2

45
Q

Describe Spondylolisthesis.

A
  • ANTERIOR displacement of one vertebrae in relation to the one below
  • Often occurs at L4 or L5
  • Usually from fatigue fractures of the Pars Interarticularis
  • Grading:
  • 1 = 0-25%
  • 2 = 25-50%
  • 3 = 50-75%
  • 4 = 75-100%
46
Q

Describe Spondyloysis.

A
  • Defect of the Pars Interarticularis withOUT anterior displacement of the vertebral body
  • Scotty Dog fracture on OBLIQUE X-ray
47
Q

Describe Spondylosis.

A
  • Radiographical term for degenerative changes within the INTERVERTEBRAL DISC and ANKYLOSING of adjacent vertebral bodies
  • Anterior Lipping of vertebral bodies
48
Q

X-ray Diagnosis:

  • Spondylolisthesis
  • Spondylolysis
A

X-ray Diagnosis:
-Spondylolisthesis: LATERAL view

-Spondylolysis: OBLIQUE view

49
Q

What ligament divides the Greater and Lesser Sciatic Foramen?

A

Sacrospinous L.

50
Q

Sacral Motion Axis: Respiration

A

-Superior Transverse axis at S2

51
Q

Sacral Motion Axis: Inherent (Craniosacral) motion

A

-Superior Transverse axis

52
Q

Sacral Motion Axis: Postural motion

A

-Middle Transverse axis

53
Q

Sacral Motion Axis: Dynamic motion

A

Engages 2 Sacral OBLIQUE Axes:

  • Left Oblique axis - weight bearing on Left leg (stepping forward with right leg)
  • Right Oblique axis - weight bearing on Right leg (stepping forward with left leg)
54
Q

During Inhalation, what is the motion of the Sacral Base?

A

Inhalation - Sacral Base moves POSTERIOR

55
Q

During Exhalation, what is the motion of the Sacral Base?

A

Exhalation - Sacral Base moves ANTERIOR

56
Q

During Craniosacral Flexion, what is the motion of the Sacral Base?

A

Sacral Base rotates Posteriorly (COUNTERNUTATION)

57
Q

During Craniosacral Extension, what is the motion of the Sacral Base?

A

Sacral Base rotates Anteriorly (NUTATION)

58
Q

As person begins to bend Forward, what is the motion of the sacral base?

A

Moves Anteriorly

59
Q

What happens to the Sacral Base as a person reaches Terminal Flexion?

A

Sacrotuberous ligaments become taut and the Sacral Base moves POSTERIORLY

60
Q

Sacral Torsion definition.

A

Sacral rotation about an OBLIQUE axis with Somatic Dysfunction at L5

61
Q

What are the Sacral Torsion Rules?

A

1-When L5 is Sidebent, a Sacral Oblique axis is engaged on the Same Side as the Sidebending

3#-The seated flexion test is found on the Opposite side of the Oblique Axis

62
Q

Sacral Torsion Example: L5 F RrSr

  • Seated Flexion:
  • Sacrum findings:
A

Sacral Torsion Example: L5 FRrSr

  • Seated Flexion: Positive on LEFT
  • Sacrum findings: Rotated to the Left on a Right Oblique axis (L on R)
63
Q

Sacral Torsion Example: L5 N SlRr

  • Seated Flexion:
  • Sacrum findings:
A

Sacral Torsion Example: L5 N SlRr

  • Seated Flexion: Positive on RIGHT
  • Sacrum findings: Rotated to the Left on a Left oblique axis (L on L)
64
Q

In sacral torsions, L5 will ALWAYS rotate in the (same or opposite) direction of the sacrum.

A

Opposite

65
Q

Due to birth mechanics, what is the most common Sacral dysfunction in the post-partum patient?

A

Bilateral Sacral Flexion

66
Q

What are the Rotator Cuff muscles?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

67
Q

What is the primary action of Supraspinatus m.?

A

Abduction of arm

68
Q

What is the primary action of Infraspinatus m.?

A

External rotation of arm

69
Q

What is the primary action of Teres minor m.?

A

External rotation of arm

70
Q

What is the primary action of Subscapularis m.?

A

Internal rotation of arm

71
Q

What is the most common type of Brachial Plexus injury?

A

Erb-Duchenne’s palsy

-injury to C5&C6 nerve roots

72
Q

Erb-Duchenne’s plasy can result in paralysis of what muscles?

A
  • Deltoid
  • External rotators
  • Biceps
  • Brachioradialis
  • Supinator
73
Q

INCREASED carrying angle of the elbow (>15˚).

  • is called:
  • ulna movement:
  • wrist movement:
A

Increased carrying angle of the elbow (>15˚).

  • is it called: Cubitus Valgus
  • ulna movement: ABduction
  • wrist movement: ADDuction
74
Q

DECREASED carrying angle of the elbow (<3˚).

  • is called:
  • ulna movement:
  • wrist movement:
A

DECREASED carrying angle of the elbow (<3˚).

  • is called: Cubitus Varus
  • ulna movement: ADDuction
  • wrist movement: ABduction
75
Q

Cubitus Valgus is associated with what Ulnar movement?

A

ABduction

76
Q

Cubitus Varus is associated with what Ulnar movement?

A

ADDuction

77
Q

Describe Pronation of the ankle.

A
  • Dorsiflexion
  • Eversion
  • Abduction
78
Q

Describe Supination of the ankle.

A
  • Plantarflexion
  • Inversion
  • Adduction
79
Q

Fibular head glide w/:

  • Pronation:
  • Supination:
A

Fibular head glide w/:

  • Pronation: Anterior glide
  • Supination: Posterior glide
80
Q

The common peroneal nerve (common fibular n.) lies directly _________ to the proximal fibular head.

A

Posterior

81
Q

What nerve would most likely be involved with a posterior fibular head dysfunction?

A

Peroneal n. (aka Common fibular n.)

82
Q

What structures are involved in O’Donahue’s traid (aka Terrible Triad)?

A
  • ACL
  • MCL
  • Medial meniscus
83
Q

The ankle is more stable in Dorsiflexion or Plantarflexion?

A

Dorsiflexion

84
Q

What is the most common injured ligament in the foot?

A

Anterior Talofibular ligament

85
Q

What makes up the Primary Respiratory Mechanisms (PRM)? (5 things)

A
  • CNS
  • CSF
  • Dural membranes
  • Cranlal bones
  • Sacrum
86
Q

Where along the skull/spinal does the Dura Mater attach? (4 places)

A
  • Foramen magnum
  • C2
  • C3
  • S2
87
Q

What 4 things are associated with Craniosacral Flexion?

A

1-Flexion of the midline bones
2-Sacral base Posterior (counternutation)
3-Decreased AP diameter of the cranium
4-External rotation of the paired bones

88
Q

What suture is present at birth till around 6 y/o and separates the frontal bone into 2 halves?

A

Metopic suture

89
Q

What is the Pterion?

A

Junction of these bones:

  • Temporal
  • Parietal
  • Spenhoid
  • Frontal
90
Q

What 4 things are associated with Craniosacral Extension?

A

1-Extension of the midline bones
2-Sacral base Anterior (nutation)
3-Increased AP diameter
4-Internal rotation of the paired bones

91
Q

What is the result of a compression strain of the Sphenobasilar Synchondrosis (SBS)?

A

Severely DEcreased CRI

*usually d/t trauma, especially to the back of the head

92
Q

Vagal somatic dysfunction can be due to what dysfunctions?

A
  • OA
  • AA
  • C2
93
Q

Dysfunction of CN VIII can cause what symptoms?

A
  • Tinnitus
  • Vertigo
  • Hearing loss
94
Q

What dysfunctions can cause suckling dysfunctions in newborns?

A
  • CN XII (condylar compression)

- CN IX & CN X (at the jugular foramen)

95
Q

What effect does the CV4 treatment have on CRI?

A

Increase amplitude

96
Q

What midline bones of the cranium?

A
  • Sphenoid
  • Occiput
  • Ethmoid
  • Vomer
97
Q

A condylar compression in a newborn might cause difficulty in what?

A

Suckling

98
Q

Where is the appendix chapman’s point?

A

Tip of the Right 12th Rib

99
Q

Do Tenderpoints or Trigger points refer pain when pressed?

A

Trigger points

100
Q

What is the myofascial release procedure?

A 
1-Palpate restriction
2-Apply compression (indirect) or traction (direct)
3-Add twisting or transverse forces
4-Use enhancers
5-Await release
101
Q

Where is the anterior tenderpoint for L5?

A

1 cm lateral to pubic symphysis on the superior ramus

102
Q

What are the ABSOLUTE contraindications to HVLA? (6)

A
  • Osteoporosis
  • Osteomyelitis (+ Pott’s dz)
  • Fractures in the area of thrust
  • Bone metastasis
  • Severe Rheumatoid Arthritis
  • Down’s syndrome
103
Q

What are the RELATIVE contraindications to HVLA? (6)

A
  • Acute whiplash
  • Pregnancy
  • Post-surgical
  • Herniated nucleus pulposus
  • Pts on Anticoagulation therapy or Hemophiliacs
  • Vertebral artery ischemia (+ Wallenbergs’s test)

COMLEX - Savarese (5 decks)

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