Term
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Definition
Application of variable manual pressure to the surface of the body for the purpose of determining the shape, size, consistency, position, inherent motility, and health of the tissues beneath |
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Term
what is somatic dysfunction? |
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Definition
Impaired or altered function of related components of the somatic system: skeletal, arthroidal and myofascial structures and related vascular, lymphatic, and neural elements |
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Term
what are the 3 steps that define the process of palpation? |
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Definition
Detection Internal amplification of magnification Analysis and Interpretation |
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Term
where are the majority of nerve endings in the hand located? |
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Definition
the pads of the fingers; Generally agreed the thumb and 2nd/3rd finger pads rather than tips are the most sensitive part to train for palpation |
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Term
what are some common errors in palpation? |
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Definition
Lack of concentration.
Too much pressure.
Excessive movement |
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Term
how is temperature evaluated prior to palpation? |
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Definition
evaluated by using the volar aspect of the wrist or the dorsal hypothenar eminence of the hand. The physician does this by placing the wrists or hands a few inches above the area to be tested and using both hands to evaluate the paravertebral areas bilaterally and simultaneously. Changes in heat distribution may be palpated paraspinally as secondary effects of metabolic processes, trauma, and so on (acute versus chronic fibrotic inflammation). Heat radiation may also be palpated in other areas of the body (e.g., extremities, abdomen). If unable to determine the thermal status of the region in question, the physician may at this point make slight physical contact with the appropriate area of the palpating hand. |
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Term
what are the steps in the examination sequence process? |
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Definition
Observation Temperature Skin topography and texture Fascia Muscle Tendon Ligament Erythema friction rub |
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Term
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Definition
movement done by the physician |
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Term
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Definition
deliberate, conscious movement by the patient |
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Term
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Definition
activity unconsciously generated within body |
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Term
individuals can perceive tissue movement as small as ___ mm |
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Definition
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Term
what is the osteopathic diagnostic criteria for somatic dysfunction? |
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Definition
TART; tissue texture abnormality, asymmetry, restriction of motion, tenderness |
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Term
what are some signs of acute somatic dysfunction? |
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Definition
increased temperature, boggy/rough texture, increased moisture, tenderness, edema, venous congestion, redness lasts in erythema test, recent injury, acute/cutting/sharp pain, skin is warm/moist/red, local vasodilation, increased muscle tone/contraction and spasm |
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Term
what are some signs of chronic somatic dysfunction? |
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Definition
slight increase or decrease in temperature (cooling), smooth/thin or ropy/stringy texture, dry, tenderness, neovascularization, redness fades quickly or blanching occurs in erythema test, long standing, chronic/dull/aching pain, paresthesias (crawling, itching, burning), cool/pale skin, vasoconstriction due to hypersympathetic tone, decreased muscle tone, limited range of movement |
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Term
what was the Thomsonianism Reform Movement? |
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Definition
Founded in early 19th century by Samuel Thomson (known as the “puke doctor”) Used botanic medicines and did not believe in physicians By 1840s the Thomsonianians had managed to strike down the laws to license physicians in all but three states. Beginning of the patent medicine shows The largest and most popular were the Kickapoo Remidies and the Kickapoo Indian Medicine shows.
From the Thomsonian Movement came both the eclectic physicians in 1830s and the physiomedical physicians in the 1840s. |
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Term
who was the founder of osteopathic medicine in 1874? |
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Definition
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Term
who founded the american school of osteopathy in 1892? |
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Definition
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Term
who was a medical officer in the Union Army during the Civil War? |
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Definition
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Term
describe the osteopathic philosophy |
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Definition
The structure & function of the human body is interrelated forming a single dynamic unit. The healthy body possesses self-regulatory mechanisms that are self-healing in nature Illness or injury in one part of the body can affect other parts, therefore you must treat the whole person Rational treatments, based on these principles, are to include all scientifically proven therapies |
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Term
what is the difference between OPP, OMT, and OMM? |
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Definition
OPP: Osteopathic Principles and Practice A medical philosophy
OMT: Osteopathic Manipulative Treatment The therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction
OMM: Osteopathic Manipulative Medicine The application of osteopathic philosophy, structural diagnosis and use of OMT in the diagnosis and management of the patient |
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Term
what is the difference between osteopathy and osteopathic treatment? |
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Definition
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Term
what is the art of medicine? |
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Definition
A trade or craft that applies a system of principles and methods Skill that is attained by study, practice, or observation Skill arising from the exercise of intuitive faculties |
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Term
describe the OMT clinical perspective |
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Definition
emphasis on both the host and the disease in determining cause of illness; allopathic mainly focus on disease aspect |
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Term
what are the four osteopathic principles? |
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Definition
1. The person is a unit of body, mind, and spirit 2. The body is capable of self-regulation, self-healing, and health maintenance 3. Structure and function are reciprocally interrelated 4. Rational treatment is based upon an understanding of these principles |
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Term
describe self regulation and self healing |
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Definition
Body is capable of self regulation as seen in homeostasis of normal physiology (such as thermal regulation).
Self healing and health maintenance is demonstrated with normal immune response and wound healing |
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Term
what is dynamic homeostasis? |
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Definition
Internal environment adapts to the external environment Feed forward, and feedback mechanisms maintain balance Antibodies develop in response to antigens Joints, tissues, viscera are constantly having old cells replaced Muscles hypertrophy from lifting weights |
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Term
what are some applications of the osteopathic principles? |
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Definition
Osteopathic principles should direct all forms of patient care Osteopathic principles should direct physician-patient interactions Osteopathic principles should direct medical research and discovery |
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Term
the osteopathic concept allows what 3 forms of treatment? |
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Definition
medication, OMT, and surgery |
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Term
at what spinal level is the suprasternal notch? |
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Definition
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Term
at what spinal level is the angle of louis? |
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Definition
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Term
at what spinal level is the xiphoid process? |
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Definition
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Term
at what spinal level is the spine of scapula? |
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Definition
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Term
at what spinal level is the inferior angle of scapula? |
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Definition
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Term
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Definition
A soft tissue technique that utilizes an intermittent force applied perpendicular to the long axis of the muscle. |
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Term
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Definition
Separation of the origin and insertion of a muscle and/or attachments of fascia and ligaments |
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Term
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Definition
when a physician passively moves a patient’s joint from the limit of the active range through the physiologic barrier toward the anatomic barrier
gradual, palpable, increase in tension until the endpoint of the range of passive motion is reached.
characteristics of this sensed tension is called end feel |
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Term
what is physiologic motion? |
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Definition
changes in position of body structures within the normal range |
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Term
what is translatory motion? |
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Definition
motion of a body part along an axis |
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Term
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Definition
spontaneous motion of every cell, organ, system, component of the body |
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Term
what is a 'direct method' in terms of osteopathic treatment strategy? |
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Definition
any osteopathic treatment strategy by which the restrictive barrier is engaged and a final activating force is applied to correct somatic dysfunction |
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Term
what is an 'indirect method' in terms of osteopathic treatment strategy? |
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Definition
a manipulative technique where the restrictive barrier is disengaged; the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all plane and directions |
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Term
what is the neutral point or position? |
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Definition
The point of balance of an articular surface from which all the motions physiologic to that articulation may take place |
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Term
what is an anatomic barrier? |
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Definition
the limit of motion imposed by anatomic structure; the limit of passive motion |
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Term
what is an elastic barrier? |
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Definition
the range between the physiologic and anatomic barriers of motion in which passive ligamentous stretching occurs before tissue disruption |
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Term
what is a pathologic barrier? |
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Definition
permanent restriction of joint motion associated with pathological change of tissue ( e.g. contracture, osteophytes) |
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Term
what are physiologic barriers the limit of? |
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Definition
the limit of active motion |
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Term
what is a restrictive barrier? |
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Definition
a functional limit within the anatomic range of motion, which abnormally diminishes the normal physiologic range |
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Term
how is somatic dysfunction named? |
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Definition
named for the freedom or potential for motion
somatic dysfunction is a diagnosis of motion
also called the osteopathic lesion: Impaired or altered function of related components of the somatic/ body framework system: skeletal, arthrodial, myofascial and the related vascular, lymphatic and related neural elements |
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Term
_______ loss is a result of and maintained by a restrictive barrier. |
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Definition
motion; the restrictive barrier is a result of somatic dysfunction |
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Term
|
Definition
anterior motion in a sagittal plane around a transverse axis in any region of the spine |
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Term
describe backward bending |
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Definition
posterior motion (backward bending) in a sagittal plane around a transverse axis in any region of the spine |
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Term
|
Definition
motion around a vertical axis
vertebral rotation
movement in its horizontal plane around its anatomic(vertical axis) |
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Term
|
Definition
right or left motion of one or more vertebral segments in a coronal plane around an anterior-posterior axis (AP axis) (concavity in direction of motion) |
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Term
what happens if you go beyond the anatomic barrier? |
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Definition
damage is caused
absolute limit of motion imposed by the anatomic structure of a joint |
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|
Term
_____ & _____ serve as finals limits of motion |
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Definition
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|
Term
is the physiologic barrier changeable? |
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Definition
yes, can be moved allowing a greater range of active motion, by doing warm up exercises for the joint |
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|
Term
True or False: more motion is possible in passive range of motion than in active range of motion. |
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Definition
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Term
what is the effect of myofascial shortening on passive and active range of motion? |
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Definition
Increases passive range of motion
decreases active range of motion
EX: body builders who do not stretch causes build up of fibrous CT |
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Term
what is the purpose of warm-up stretches? |
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Definition
move the physiologic barrier so that active ROM will be increased |
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Term
what is the difference between major and minor motion loss? |
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Definition
Major motion loss easy to find “patient went to sleep and awoke unable to straighten head.”
Minor motion loss requires more palpatory perception must develop a palpatory sense of normal end feel - increasing resistance in PROM as the D.O. approaches the anatomical barrier |
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|
Term
what does the "end feel" indicate? |
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Definition
the endpoint of motion as you approach the anatomic barrier (fights you as you approach the anatomic barrier) |
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|
Term
which type of motion occurs in the elastic barrier range? |
|
Definition
passive motion (involuntary) |
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Term
is there an end feel in minor motion loss? |
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Definition
no, no ligamentous resistance |
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Term
true or false: minor motion loss moves the neutral point (resting point) |
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Definition
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|
Term
is a pathologic barrier a permanent change? |
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Definition
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|
Term
when the expected symmetry of motion is not found in an individual, what is assumed? |
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Definition
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|
Term
true or false: in somatic dysfunction, the new midline is shifted away from the restrictive barrier |
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Definition
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|
Term
are the structure and function of the spinal column the same over its length? |
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Definition
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|
Term
natural kyphosis and lordosis of the spine add to which type of resistance? |
|
Definition
add to elastic resistance to disc loading by redistributing weight |
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|
Term
which spinal level is in the approximate center of load bearing with ideal posture? |
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Definition
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Term
what is a vertebral unit? |
|
Definition
Two adjacent vertebrae, their joints, and the intervertebral discs between them. The vertebral unit is given the name of the superior member of the unit. Ex: motion or somatic dysfunction of “C2” means the motion of C2 on C3. Ex: motion or somatic dysfunction of “L3” means the motion of L3 on L4. |
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|
Term
|
Definition
two vertebrae and associated soft tissues |
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Term
true or false: capsular ligaments for facet articulations also contribute to stability and limitation of motion |
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Definition
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Term
the bony structure of which segment of the vertebrae is a primary determinant of intervertebral ranges of motion |
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Definition
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Term
which types of movements are allowed in the cervical vertebrae? |
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Definition
flexion, extension, sidebending and rotation |
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Term
what types of movement are allowed and restricted in the thoracic region of the spine? |
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Definition
rotation permitted; sidebending inhibited |
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Term
what types of movement are permitted and inhibited at the lumbar region of the spine? |
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Definition
flexion/extension permitted; rotation inhibited |
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Term
what is the facet orientation of the cervical region of the spine? |
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Definition
backward, upward, medial (BUM) |
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Term
what is the facet orientation of the thoracic region of the spine? |
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Definition
backward, upward, lateral (BUL) |
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Term
what is the facet orientation of the lumbar region of the spine? |
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Definition
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Term
what is Fryette's 1st principle? |
|
Definition
When sidebending is attempted from neutral (anatomical) position, rotation of vertebral bodies follows to the opposite direction
When the spine is in a neutral position (easy normal) and sidebending is introduced, the bodies of the vertebrae will rotate toward the convexity.
In a neutral position, sidebending occurs 1st with rotation 2nd in the OPPOSITE direction.
NSXRY |
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Term
what is fryette's 2nd principle? |
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Definition
When sidebending is attempted from non-neutral (hyperflexed or hyperextended) position, rotation must precede sidebending to the same side |
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Term
what is fryette's 3rd principle? |
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Definition
Motion introduced in one plane limits and modifies motion in the other planes |
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Term
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Definition
pure flexion and extension of a vertebral unit |
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Term
what is compound movement? |
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Definition
Physiologically normal movements in any of the primary directions induces additional motion vectors as a consequence of the facet orientation |
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Term
in which plane does flexion and extension (forward bending and backward bending) occur about a transverse axis? |
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Definition
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Term
what symbols represent right and left rotation of a horizontal plane about a vertical axis? |
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Definition
Right rotation = RR Left rotation = RL |
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Term
what symbols represent right and left sidebending of the coronal plane about an anterior-posterior axis? |
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Definition
Right sidebending = SR Left sidebending = SL
Approximation of transverse processes (TP) on that particular side. Ex: L TP approximate = SL Ex: R TP approximate = SR |
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Term
in the thoracic spine, neutral range occurs with forward bending or back bending? |
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Definition
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|
Term
in the lumbar spine, neutral range occurs with forward bending or back bending? |
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Definition
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Term
true or false: All spinal and vertebral movements are described in relation to motions of their anterior surfaces |
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Definition
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Term
greatest motion of the spine often occurs towards which segments? |
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Definition
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Term
true or false: in neutral mechanics, sidebending preceeds rotation |
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Definition
true
EXAMPLE: from a neutral position First sidebending left occurs As it continues, right rotation must occur to accommodate the continued motion Therefore: N SLRR |
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|
Term
describe the mechanics of sidebending |
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Definition
Sidebending “X” followed by rotation “Y” Occur in groups (may be one vertebra though) Commonly cause discomfort but not pain |
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Term
what is the notation for someone in the neutral position performing both sidebending and rotation? |
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Definition
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|
Term
what is the notation for the L3 vertebrae in the neutral position (resting lordosis), sidebent left and rotated right on L4? |
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Definition
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Term
what is the notation for the T2 vertebrae in neutral postion (resting kyphosis) and the individual sidebent right and rotated left? |
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Definition
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|
Term
describe the mechanics of fryette's 2nd principle |
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Definition
Non-Neutral Mechanics (extremes of FB and BB) Rotation “X” followed by sidebending “X” Occurs at one segment Commonly cause acute pain |
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|
Term
true or false: Type II Fryette mechanics apply only to the T & L spine |
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Definition
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Term
what is the difference between physiologic findings and somatic dysfunction? |
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Definition
Physiologic motion becomes somatic dysfunction if the segments do not return to “normal” after completion of motion. They may be pure sagittal plane dysfunctions, neutral dysfunctions, or flexed or extended non neutral dysfunctions. |
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|
Term
do fryette's type I and II mechanics apply to the cervical spine? |
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Definition
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|
Term
fryette's 3rd principle applies to which regions of the spine? |
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Definition
cervical, thoracic, lumbar spine |
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|
Term
what are the 2 divisions of the cervical spine? |
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Definition
superior and inferior division |
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|
Term
what joints occupy the superior division of the cervical spine? |
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Definition
OA (occipitoatlantal) and AA (atlantoaxial) |
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Term
describe the articulation between the atlas and the axis |
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Definition
Vertebral body of C2 is modified superiorly to form the dens(odontoid process) C1 atlas does not have a body but rotates about the dens Superiorly it articulates with the atlas at the occipital condyles via bilateral transverse masses |
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Term
describe the occipitoatlantal joint and its notation in side bending and rotation |
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Definition
Superior articular processes converge anteriorly and tilt medially. Occiput will sidebend one direction and rotate the opposite during multiple plane motion. OA SXRY
Some literature sources refer to OA as C0 |
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|
Term
the OA joint in the cervical spine accounts for what percentage of 90 degree forward and backward bending of the cervical region? |
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Definition
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|
Term
the OA joint accounts for how many degrees of forward and backward bending of the cervical spine? |
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Definition
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|
Term
normal motion of the AA joint is how many degrees of rotation in each direction? |
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Definition
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|
Term
true or false: normal range of rotation for entire cervical spine is 90 degrees in each direction |
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Definition
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|
Term
the AA joint is responsible for what percentage of rotation of the entire cervical spine? |
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Definition
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|
Term
describe coupled motion in the typical cervical vertebrae |
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Definition
rotate and sidebend to same side C2=motion of C2 on C3 C3=motion of C3 on C4 C4=motion of C4 on C5 C5=motion of C5 on C6 C6=motion of C6 on C7 C7=motion of C7 on T1 |
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|
Term
the inferior division of the cervical spine (C2-C7) accounts for what percentage of forward bending and back bending? |
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Definition
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|
Term
the inferior division of the cervical spine (C2-C7) accounts for what percentage of cervical rotation to the right and left? |
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Definition
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|
Term
true or false: rotation and sidebending in the inferior division of the cervical spine will occur to the same side regardless of injury |
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Definition
true; Because of the 10-45 deg angle of the synovial facets in the cervical area, the uncinate processes, the joints of Luschka, and the shape and location of the disks |
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|
Term
full flexion and extension of total cervical spine has a combined range of how many degrees? |
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Definition
180 degrees in the sagittal plane |
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|
Term
A patient with a gastric ulcer is found to have the following during an osteopathic structural exam: T5 E RL SL (extended, rotated left, sidebent left). Sidebending occurs in which plane? |
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Definition
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|
Term
A patient with a gastric ulcer is found to have the following during an osteopathic structural exam: T5 E RL SL (extended, rotated left, sidebent left). Extension occurs in which plane? |
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Definition
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Term
A patient with a gastric ulcer is found to have the following during an osteopathic structural exam: T5 E RL SL (extended, rotated left, sidebent left). Rotation occurs in around which axis? |
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Definition
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|
Term
the sagittal plane rotates on which axis? |
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Definition
transverse (horizontal) axis |
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|
Term
the horizontal (transverse) plane rotates on which axis? |
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Definition
longitudinal (vertical) axis |
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|
Term
the coronal (frontal) plane rotates on which axis? |
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Definition
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|
Term
what type of movement is allowed by a plane joint? |
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Definition
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|
Term
what type of movement is allowed by a ball and socket joint? |
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Definition
Permits flexion, extension, adduction, abduction, circumduction, & axial rotation Triaxial + circumduction |
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|
Term
motion occurs in how many planes in a hinge joint? |
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Definition
one plane, allows only flexion and extension |
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|
Term
what is movement limited to in a pivot joint? |
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Definition
rotation, motion in only one plane |
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|
Term
what types of movement are allowed by a condyloid joint? |
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Definition
Permits flexion, extension, adduction, abduction, & circumduction, but NO axial rotation Biaxial + circumduction |
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|
Term
what type of movement is allowed by a saddle joint? |
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Definition
Permits flexion, extension, adduction, abduction, & circumduction, but NO axial rotation Biaxial + circumduction |
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|
Term
describe the sternoclavicular joint |
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Definition
Joins the sternum to the clavicle
Only articulation of the shoulder girdle with the trunk
Movement - limited, but in every direction
Elevation & depression of clavicle on sternum AP axis
Protraction & retraction of shoulder girdle Longitudinal axis
Internal & external rotation of shoulder girdle Transverse axis |
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|
Term
what are some examples of plane joints? |
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Definition
Acromioclavicular Tibiofibular Joint Sacroiliac Joint |
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|
Term
describe the acromioclavicular joint |
|
Definition
Connects the clavicle with the acromion process of the scapulae
Movement – more limited than SC joint, but in every direction
Elevation & depression of clavicle on acromion process AP axis
Protraction & retraction of shoulder girdle Longitudinal axis
Internal & external rotation of shoulder girdle Transverse axis |
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|
Term
describe the tibiofibular joint |
|
Definition
Connected by a synovial joint at the proximal end and a fibrous joint (syndesmosis) at the distal end
Interosseus membrane between
Movement – limited, proximal > distal Anterolateral & posteromedial glide of fibular head on tibia no axis Superior & inferior glide of fibular head on tibia no axis When foot is pronated & supinated, respectively Glide is reciprocal between proximal & distal tibiofibular joints Eg: proximal glides anterolateral, distal glides posterior |
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|
Term
describe the sacroiliac joint |
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Definition
Connection of the sacrum and iliac bones of the pelvis
Movement – Limited (but important) Slight gliding possible – increased during pregnancy Anterior & posterior Superior & inferior Lateral & medial |
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|
Term
describe the glenohumeral joint |
|
Definition
“Shoulder Joint”
Inserts the humeral head into the glenoid fossa of scapula
Movement – full range of motion in every direction
Flexion & extension of humerus Transverse axis
Adduction & abduction of humerus AP axis
Internal & external rotation of humerus Longitudinal axis
Circumduction |
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|
Term
describe the femoroacetabular joint |
|
Definition
“Hip Joint”
Inserts femoral head into acetabulum of hip bone
Movement Flexion & extension of hip Transverse axis
Adduction & abduction of hip AP axis
Internal & external rotation of hip Functional Longitudinal axis
Circumduction |
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|
Term
describe the humeroulnar joint |
|
Definition
“Elbow Joint”
True Elbow Joint direct connection of humerus to ulna
Radius is NOT part of true elbow joint
Movement – approximately 190° of motion Flexion & extension of ulna on humerus Transverse axis |
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|
Term
describe interphalangeal joints |
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Definition
Of hands and feet, joints between the phalanges
Proximal interphalangeal joints (PIP) and distal interphalangeal joints (DIP)
Movement Flexion & extension of distal phalynx about proximal phalynx Transverse axis |
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|
Term
describe the femorotibial joint |
|
Definition
“Knee Joint”- Largest joint in the body True Knee Joint- connects the two condyles of the femur to the tibial plateau Two semilunar cartilages (menisci) on each side of joint The patella is excluded from the true knee joint
Hinge-type Joint with Plane Joint movements as well
Movement – approximately 160° of motion Flexion & extension of knee Transverse axis Six gliding motions of tibia on femur no axis Anterior & Posterior Anteromedial & Posterolateral Medial & Lateral |
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|
Term
describe the temporomandibular joint |
|
Definition
Connects the mandible with the temporal bone of the skull Fibrous articular disc in between Modified Hinge Joint with Gliding Joint movements Movement Depression & elevation of mandible Transverse axis Protraction & retraction of mandible No true axis Slight lateral deviation (gliding) No axis |
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|
Term
describe the radioulnar joint |
|
Definition
Connects the radius and ulna Strengthened by the interosseus membrane
Movement – greater movement distally Pronation & supination of radius on ulna Longitudinal axis |
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|
Term
describe an ellipsoid joint |
|
Definition
Elliptical convex articular surface that fits elliptical concave articular surface
flexion, extension, abduction and adduction, but no rotation.
Example Radiocarpal joint. |
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|
Term
describe the radiocarpal joint |
|
Definition
True Wrist Joint- Connects the distal radius with the carpal bones Scaphoid, lunate, triquetral bones Ulna is excluded from the true wrist joint
Movement Flexion & extension of wrist Transverse axis Abduction & adduction of wrist AP axis Circumduction of wrist No true rotation |
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|
Term
true or false: somatic dysfunction is always named for its freedom of motion |
|
Definition
true; named for the directions in which the vertebra or other joint can move more easily |
|
|
Term
what are TART changes in general? |
|
Definition
part objective and part subjective findings |
|
|
Term
what categories would one use to test tenderness of a region? |
|
Definition
O: Onset P: Provocation / Palliation Q: Quality / Quantity R: Radiation / Region S: Severity T: Time |
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|
Term
how can one test asymmetry in an individual? |
|
Definition
Visual observation Static positional asymmetry, use of landmarks and tissues Active range of motion Inspect levelness of horizontal planes
Palpatory observation Muscle tone, tissue texture, quality of joint motion, etc. |
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|
Term
how would one test the restriction of motion in an individual? |
|
Definition
Visual and palpatory inspection Ease of effort: Difficult? Easy? Quality: Smooth? Interrupted? Crepitus? Quantity: Increased ROM? Decreased ROM? End feel of ROM: Barrier Concept |
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|
Term
how would one test tissue texture changes in an individual? |
|
Definition
|
|
Term
when rotation occurs towards the convexity of the spinal curve, this is termed what type of somatic dysfunction? |
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Definition
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Term
when rotation of the vertebra occurs into the concavity of the spinal curve, this is termed what type of somatic dysfunction? |
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Definition
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Term
it is generally recommended that the physician observe what about the patient first in layer by layer palpation? |
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Definition
It is recommended the physician begin with general observation of the static posture and then dynamic posture (gait and regional range of motion)
For safety, it is best to begin by observing function and range of motion with active regional motion testing
After examining the patient in this manner, the physician may decide to observe the patient's limits by passive range of motion (ROM) testing
The passive ranges should typically be slightly greater than those elicited during active motion assessment
After identifying any asymmetries or abnormalities at this point, it is reasonable to proceed to the palpatory examination |
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Term
what is the final step in examination of a patient for somatic dysfunction layer by layer? |
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Definition
The final step in the examination is to determine whether there is a related articular component to the patient's problem This involves controlling a joint and putting it through very fine small motion arcs in all phases of its normal capabilities (intersegmental motion testing)
The physician attempts with a three-plane motion examination to determine whether the motion is normal and symmetric or whether pathology is restricting motion, with or without asymmetry in the cardinal axes For example, the C1 segment may be restricted within its normal physiologic range of rotation and exhibit either a bilaterally symmetric restriction in rotation (e.g., 30 degrees right and left) or an asymmetry of motion with greater freedom in one direction than the other (e.g., 30 degrees right, 40 degrees left). As stated previously, most descriptions of somatic dysfunction relate to the asymmetric restrictions, but symmetric restrictions are seen clinically |
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Term
what are the common landmarks used to test for horizontal symmetry or asymmetry? |
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Definition
Landmarks such as the tibial tuberosities, anterior superior iliac spines, posterior superior iliac spines, iliac crests, nipples, shoulders at the acromioclavicular joint, earlobes, and eyes as horizontal levels plane are often used for this purpose |
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Term
what are some predisposing factors to somatic dysfunction? |
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Definition
Posture habitual, occupational
Gravity
Anomalies vertebra, facets
Transitional areas occipito-atlantal C7-T1 T12-L1 L5-S1
Muscle hyperirritability
Physiologic locking of joint
adaptation to stressors
compensation for other structural deficits - stable |
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Term
the ____ ____ is the organizer of information, which is processed from the brain to other regions |
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Definition
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Term
describe the autonomic nervous system in general and its functions |
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Definition
Involuntary manager components: antagonistic vs. cooperative/cooperative effects Sympathetic Nervous System Parasympathetic Nervous System
Controls moment-by-moment activity of viscera Somatic component often thought of as separate system Somatic component has undeniable effects on the autonomic nervous system, and vice versa |
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Term
describe the sympathetic nervous system in general |
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Definition
sympathetic chains T1 to L2 bilaterally exit with somatic motor axons via intervertebral foramina travel with somatic axons for much of their course inferior to the head and neck of ribs posterior to pleura
“flight or fight” response constantly moderated and adjusted reactions fine tunes visceral function regulates circulation, metabolism, smooth muscle tone, intestinal motility, cardiac function, pulmonary response |
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Term
describe the parasympathetic nervous system in general |
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Definition
cranial portion - ganglia associated with third, seventh, ninth, & tenth cranial nerves sacral portion - spinal segments S2, S3, S4. ganglia located close to innervated organ primary function is internal maintenance, including digestion and excretion most effective during recovery and rest |
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Term
describe the somatic nervous system in general |
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Definition
under voluntary control some functions are automatic typical spinal nerve is formed by joining of ventral and dorsal roots inside the vertebral canal. all skeletal muscle nerves arise or terminate in common origins in the spinal cord and exit via the vertebral foramina |
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Term
what is a somatic reflex arc? |
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Definition
Afferent and Efferent fibers pass in the same nerve
An afferent stimulus causes a reflex response via somatic efferent fibers
Responsible for all aspects of T.A.R.T |
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Term
what is a visceral reflex arc responsible for? |
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Definition
responsible for visceral dysfunction; same reflex pattern as a somatic reflex arc |
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Term
during sympathetic activation, what happens to the pupils? |
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Definition
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Term
during parasympathetic activation, what happens to the pupils? |
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Definition
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Term
during parasympathetic activation, what happens to the ciliary muscle? |
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Definition
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Term
during parasympathetic activation what happens to the lacrimal gland? |
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Definition
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Term
during sympathetic activation, what happens to the mucous, parotid, submaxillary and sublingual glands? |
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Definition
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Term
during parasympathetic activation, what hapens to the mucous, parotid, submaxillary and sublingual glands? |
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Definition
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Term
during sympathetic activation what happens to blood vessels? |
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Definition
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Term
during sympathetic activation, what happens to pilomotor muscles? |
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Definition
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Term
during sympathetic activation, what happens to sweat glands? |
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Definition
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Term
during sympathetic activation, what happens to the common carotid artery and mucous & thyroid gland? |
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Definition
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Term
during parasympathetic activation, what happens to the mucous glands? |
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Definition
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Term
during sympathetic activation, what happens to the heart? |
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Definition
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Term
during parasympathetic activation, what happens to the heart? |
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Definition
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Term
during sympathetic activation, what happens to bronchial muscle? |
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Definition
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Term
during parasympathetic activation, what happens to bronchial muscle? |
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Definition
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Term
during sympathetic activation what happens to bronchial glands? |
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Definition
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Term
during parasympathetic activation, what happens to bronchial glands? |
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Definition
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Term
during sympathetic activation, what happens to upper body vasculature? |
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Definition
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Term
during sympathetic activation what happens to the stomach? |
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Definition
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Term
during parasympathetic activation what happens to the stomach? |
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Definition
secretion and motor function |
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Term
what occurs in the liver during sympathetic activation? |
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Definition
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Term
what occurs in the liver during parasympathetic activation? |
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Definition
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Term
what occurs in the spleen during sympathetic activation? |
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Definition
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Term
what occurs in the gallbladder and ducts during sympathetic activation? |
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Definition
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Term
what occurs in the gallbladder and ducts during parasympathetic activation? |
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Definition
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Term
what occurs in the pancreas during sympathetic activation? |
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Definition
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Term
what occurs in the pancreas during parasympathetic activation? |
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Definition
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Term
what are some symptoms of acute hypersympathetonia? |
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Definition
Stimulation of sweat glands Increased metabolic activity Vasoconstriction, but overridden by: Biochemical inflammation Bradykinins, Serotonin, Histamine, Prostaglandin Resulting in vasodilation = warmth, redness, edema/bogginess |
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Term
what is acute sympathetic hyperactivity? |
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Definition
Heat produced from bradykinin and substances released during local tissue injury This is chemical local vasodilation that “hides” the vasoconstriction of acute sympathetic hyperactivity This local response also will cause redness, “erythema” “rubor” |
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Term
what is chronic hypersympathetonia? |
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Definition
Long-standing sympathetic overstimulation
Causes peripheral vasoconstriction Chronic congestion leads to increased tissue collagen, and fibrosing of tissue |
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Term
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Definition
An area on the skin that responds to stimuli by turning red after stimulation by palpation
Normal response fades fairly rapidly
Response is different for acute somatic dysfunction and chronic somatic dysfunction |
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Term
what are some acute red reflex findings? |
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Definition
Palpatory stimulation results in: Redness which remains longer than the rest of the area tested Sympathetic response causes vasoconstriction. However, this response is overridden by local biochemical responses, leading to warmth and redness. Indicates either acute S/D in that segmental area, or S/D secondary to visceral dysfunction innervating that segment |
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Term
what are some signs of chronic red reflex? |
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Definition
Palpatory stimulation results in: Initial redness followed by blanching of the tissues before the rest of the area blanches Chronic hypersympathetic tone causes vasoconstriction and decreased blood flow to tissues. Tissues have been altered for extended time leading to increased fibrosis, decreased circulation, decreased local response, trophic changes |
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Term
describe the segmental nature of the sympathetic nervous system |
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Definition
Painful stimuli from the viscera are carried back to the cord via the sympathetics Less well known than somatic system Aids in diagnosis heart - T1 to T5, chest, shoulder, neck, jaw Asthma- T2 appendix - periumbilical pain innervation is derived from T10-T11, as is the area around the umbilicus Prostate -T12-L2 |
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Term
what is a viscerosomatic reflex? |
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Definition
A viscerosomatic reflex is one in which disruption, irritation, or disease of an internal organ or tissue results in reflex dysfunction of a segmentally related musculoskeletal region |
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Term
what is the osteopathic goal? |
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Definition
The goal of manipulation is to restore the whole body to a state of homeostasis. This is not some standardized posture to be rigidly applied in all cases but is individually tailored to the patient |
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Term
what are somatovisceral reflexes? |
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Definition
disruption of the function of viscera by somatic dysfunctions |
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Term
what are some contraindications for soft tissue? (times when you should NOT perform soft tissue palpation) |
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Definition
Acute sprain or strain. Fracture or dislocation. Neurologic or vascular compromise. Osteoporosis and osteopenia. Malignancy. Most restrictions are for treatment in the affected area of malignancy; however, care should be taken in other distal areas depending on type of malignancy and/or lymphatic involvement. Infection (e.g., osteomyelitis). Laceration Open wounds Acute process going on and you are unsure of the exact diagnosis Medicolegal issues |
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Term
true or false: one should never apply direct force directly into bone and should limit pressure on the muscle belly |
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Definition
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Term
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Definition
stroking movement used to move lymphatic fluid; motion is towards the heart in most cases |
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Term
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Definition
deep kneading or squeezing action; Involves pinching or tweaking one layer and lifting it or twisting it away from deeper areas |
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Term
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Definition
striking the belly of a muscle with the hypothenar edge of the open hand in rapid succession in order to increase its tone and arterial perfusion; A hammering, chopping percussion of tissues to break adhesions and/or encourage bronchial secretions |
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Term
describe the steps involved in performing a suboccipital release of the patient in the supine position |
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Definition
1. The patient lies supine on the treatment table. 2. The physician sits at the head of the table. 3. The physician's finger pads are placed palm up beneath the patient's suboccipital region, in contact with the trapezius and its immediate underlying musculature 4. The physician slowly and gently applies pressure upward into the tissues for a few seconds and then releases the pressure 5. This pressure may be reapplied and released slowly and rhythmically until tissue texture changes occur or for 2 minutes. The pressure may also be continued in a more constant inhibitory style for 30 seconds to 1 minute |
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Term
describe the steps performed by the physician in forward bending (bilateral fulcrum) of the patient in the supine position |
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Definition
1. The patient lies supine on the treatment table. 2. The physician is seated at the head of the table. 3. The physician's arms are crossed under the patient's head and the physician's hands are placed palm down on the patient's anterior shoulder region 4. The physician's forearms gently flex the patient's neck, producing a longitudinal stretch of the cervical paravertebral musculature 5. This technique may be performed in a gentle, rhythmic fashion or in a sustained manner. 6. Tissue tension is reevaluated to assess the effectiveness of the technique. |
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Term
how would a physician perform contralateral traction on a patient in the supine position? |
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Definition
1. The patient lies supine on the treatment table. 2. The physician stands at the side of the table opposite the side to be treated. 3. The physician's caudad hand reaches over and around the neck to touch with the pads of the fingers the patient's cervical paravertebral musculature on the side opposite the physician 4. The physician's cephalad hand lies on the patient's forehead to stabilize the head 5. Keeping the caudad arm straight, the physician gently draws the paravertebral muscles ventrally, producing minimal extension of the cervical spine 6. This technique may be performed in a gentle, rhythmic, and kneading fashion or in a sustained manner. 7. Tissue tension is reevaluated to assess the effectiveness of the technique |
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Term
how would a physician perform cradling with traction (longitudinal stretch) on a patient in the supine position? |
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Definition
1. The patient lies supine on the treatment table. 2. The physician sits at the head of the table. 3. The physician's fingers are placed under the patient's neck bilaterally, with the fingertips lateral to the cervical spinous processes and the finger pads touching the paravertebral musculature overlying the articular pillars 4. The physician exerts a gentle to moderate force, ventrally to engage the soft tissues and cephalad to produce a longitudinal tractional effect (stretch). 5. This traction on the cervical musculature is slowly released. 6. The physician's hands are repositioned to contact different levels of the cervical spine, and steps 4 and 5 are performed to stretch various portions of the cervical paravertebral musculature 7. This technique may be performed in a gentle rhythmic and kneading fashion or in a sustained manner. 8. Tissue tension is reevaluated to assess the effectiveness of the technique |
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Term
how would a physician perform a trapezius stretch? |
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Definition
1. Patient supine, doctor at head of table 2. Stabilize one shoulder with opposite hand 3. With free hand contact same side of head as stabilized shoulder and introduce GENTLE stretch |
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Term
when would a physician decide to perform effleurage on a patient? |
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Definition
patient complains of congestion in the face or nose
when you put your hands on the skin it feels warm or puffy or edematous |
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Term
how would a physician perform effleurage? |
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Definition
patient supine, doc seated at head of bed
doctor uses 2 or 3 fingers to firmly contact the forehead between the eyebrows
keeping firm contact, move the fingers upward and outward around the ridge of the eyebrows
as you reach the lateral part of the eyebrows, and still keeping contact, direct your hands down toward the jaw
repeat 3-4 times
reassess |
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Term
how would a physician perform inhibition on a patient? |
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Definition
doctor locates an area of TART changes within the thoracic spine
using the thumb or 1 or 2 fingers, press directly on the affected area
maintain firm pressure downward (toward the floor) until the tissue under your finger softens
re-assess |
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Term
how would a physician perform longitudinal stretching on a patient? |
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Definition
patient lying face down doctor stands at side of table, on same side as the dysfunction doc crosses forearms heels of hands are resting on the skin, about 3 inches apart bring the heels together, bunching up the skin keeping your arms straight, drop your body weight onto your arms and hands – this will bring you into contact with the muscle layer separate your hands repeat in a rhythmic fashion re-assess |
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Term
how would a physician perform tapotement? |
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Definition
patient face down
doctor standing on side of dysfunction
doctor positions hands with pinky side toward floor and thumb side toward ceiling
doctor lightly and quickly taps the patient’s paravertebral musculature repeatedly with the pinky side of the hand
re-assess |
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Term
how would a physician perform a rhomboid stretch on a patient? |
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Definition
1. patient lying face down 2. doc standing at head of bed 3. doc crosses forearms 4. heels of hands are resting on the skin, about 3 inches apart 5. bring the heels together, bunching up the skin 6. keeping your arms straight, drop your body weight onto your arms and hands – this will bring you into contact with the muscle layer 7. separate your hands 8. repeat in a rhythmic fashion |
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Term
describe how to perform prone pressure (kneading) in the thoracic region on a patient |
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Definition
1. The patient is prone, preferably with the head turned toward the physician. (If the table has a face hole, the head may be kept in neutral.) 2. The physician stands at the side of the table opposite the side to be treated. 3. The physician places the thumb and thenar eminence of one hand on the medial aspect of the patient's thoracic paravertebral musculature overlying the transverse processes on the side opposite the physician 4. The physician places the thenar eminence of the other hand on top of the abducted thumb of the bottom hand or over the hand itself. 5. Keeping the elbows straight and using body weight, the physician exerts a gentle force ventrally (downward) to engage the soft tissues, and then laterally, perpendicular to the thoracic paravertebral musculature. 6. This force is held for a few seconds and is slowly released. 7. Steps 5 and 6 can be repeated several times in a gentle, rhythmic, and kneading fashion. 8. The physician's hands are repositioned to contact different levels of the thoracic spine, and steps 5 to 7 are performed to stretch various portions of the thoracic paravertebral musculature. 9. This technique may also be performed using deep, sustained pressure. 10. Tissue tension is reevaluated to assess the effectiveness of the technique. |
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Term
describe the steps taken by a physician performing lateral recumbent kneading on the middle/lower thoracic region of a patient |
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Definition
1. Patient on left side; doctor facing patient 2. Doctor’s fingers in PVM sulcus lateral to spinal processes 3. Stabilize forearms on patients shoulder and hips 4. Pull tissues toward you while simultaneously pushing elbows toward floor |
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Term
describe the steps taken by a physician performing lateral recumbent kneading in the upper thoracic region of a patient |
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Definition
1. Patient on left side; doctor facing patient 2. Let patient’s arm fall over caudad arm 3. Grasp PVM with fingers and pull toward you 4. Flip patient’s arm over cephalad arm and work behind rhomboid muscles |
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Term
describe how a physician would perform supine kneading on a patient's thoracic region |
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Definition
1. Patient supine, doctor sitting at either side 2. Slide hands under patient until pads of fingers touch PVM near you 3. Leaning onto elbows create a fulcrum and press fingers up into tissues and draw them near to you |
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Term
describe how a physician would perform supine kneading in a patient's lumbar region |
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Definition
1. Patient supine, doctor sitting at either side 2. Slide hands under patient until pads of fingers touch PVM near you 3. Leaning onto elbows create a fulcrum and press fingers up into tissues and draw them near to you |
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Term
what are the steps involved in performing petrissage on a patient? |
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Definition
1. patient lying face up 2. doctor seated at side of table 3. palpate by placing fingers into the tissues above the muscle layer and moving gently to locate an area that doesn’t move as well as the other areas 4. grasp the skin and subcutaneous tissues between your fingers and thumb 5. move the tissues until tension is felt 6. lift the tissue and move it further in the direction of tension – a kind of rolling motion 8. repeat as necessary 9. re-assess |
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Term
how would a physician perform longitudinal stretching on a patient? |
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Definition
1. patient lying face down 2. doctor stands at side of table, on same side as the dysfunction 3. doc crosses forearms 4. heels of hands are resting on the skin, about 3 inches apart 5. bring the heels together, bunching up the skin 6. keeping your arms straight, drop your body weight onto your arms and hands – this will bring you into contact with the muscle layer 7. separate your hands 8. repeat in a rhythmic fashion 9. re-assess |
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Term
describe how a physician would perform prone pressure with counterleverage (kneading) on a patient's lumbar region |
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Definition
1. The patient is prone with the head turned toward the physician. (If the table has a face hole, keep the head in neutral.) 2. The physician stands at the side of the table opposite the side to be treated. 3. The physician places the thumb and thenar eminences of the cephalad hand on the medial aspect of the paravertebral muscles overlying the lumbar transverse processes on the side opposite the physician. 4. The physician's caudad hand contacts the patient's anterior superior iliac spine on the side to be treated and gently lifts toward the ceiling. 5. To engage the soft tissues, the physician's cephalad hand exerts a gentle force ventrally and laterally, perpendicular to the lumbar paravertebral musculature. 6. This force is held for several seconds and is slowly released. 7. Steps 4 to 6 are repeated several times in a slow, rhythmic, and kneading fashion 8. The physician's cephalad hand is then repositioned to contact different levels of the lumbar spine and steps 4 to 6 are performed to stretch various portions of the lumbar paravertebral musculature. 9. This technique may also be performed using deep, sustained pressure. 10. Tissue tension is reevaluated to assess the effectiveness of the technique. |
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Term
what is the scissors technique used by physicians in the lumbar region? |
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Definition
1. The patient is prone, with the head turned toward the physician. (If the table has a face hole, keep the head in neutral.) 2. The physician stands at the side of the table opposite the side to be treated. 3. On the side to be treated, the physician's caudad hand reaches over to grasp the patient's leg proximal to the knee or at the tibial tuberosity. 4. The physician lifts the patient's leg, extending the hip and adducting it toward the other leg to produce a scissors effect. 5. The physician's caudad hand may be placed under the far leg and then over the proximal leg so that the patient's leg can support the physician's forearm. 6. The physician places the thumb and thenar eminence of the cephalad hand on the patient's para-vertebral musculature overlying the lumbar trans-verse processes to direct a gentle force ventrally and laterally to engage the soft tissues while simultaneously increasing the amount of hip extension and adduction. 7. This force is held for several seconds and is slowly released. 8. Steps 6 and 7 are repeated several times in a slow, rhythmic, and kneading fashion. 9. The physician's cephalad hand is then repositioned to contact other levels of the lumbar spine and steps 6 to 8 are performed to stretch the various portions of the lumbar paravertebral musculature. 10. This technique may also be performed using deep, sustained pressure. 11. Tissue tension is reevaluated to assess the effectiveness of the technique |
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Term
how would a physician perform combined kneading and stretching on a patient? |
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Definition
1. patient lying on side with knees bent 2. doc standing facing patient 3. place the forearm of the arm nearest the feet in the iliac fossa 4. place the other forearm in the patient’s axilla 5. the hands should now be cupping the paravertebral muscles 6. lean your body weight onto your forearms – this accomplishes 3 motions at once a. the forearm in the iliac fossa comes closer to the doctor b. the forearm in the axilla moves away from the doctor c. the hands move toward the patient’s side and the doctor’s chest 7. a + b creates a stretch – the ends of the muscle get further apart 8. c creates a kneading motion – the hands are moving perpendicular to the long axis of the muscle 9. repeat in rhythmic fashion 10.re-assess |
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Term
define an indirect method |
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Definition
A manipulative technique where the restrictive barrier is disengaged The dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions Simply put: Take the dysfunction the way it “likes” to go! |
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Term
true or false: muscles tend to tighten with inhalation and relax with exhalation |
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Definition
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Term
what occurs in the thoracic vertebrae during inhalation? |
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Definition
external rotation, spinal curves tend to flatten |
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Term
what occurs in the thoracic vertebrae during exhalation? |
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Definition
internal rotation, spinal curves tend to increase |
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Term
what year was osteopathic medicine founded? |
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Definition
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|
Term
what year was the american school of osteopathy founded? |
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Definition
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Term
during what years was A.T. Still alive? |
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Definition
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Term
T3 likes to sidebend to the left side, right lateral pillar is prominent. what is the diagnosis? |
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Definition
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Term
what is isometric muscle contraction? |
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Definition
maintains constant muscle length |
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Term
what is isotonic muscle contraction? |
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Definition
tension remains unchanged, muscle length changes |
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Term
what is isolytic muscle contraction? |
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Definition
forcing the muscle to lengthen |
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Term
what is concentric muscle contraction? |
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Definition
contraction that results in shortening of muscle |
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Term
what is eccentric muscle contraction? |
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Definition
lengthening of muscle during contraction (due to external force) |
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Term
when should one use indirect techniques? |
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Definition
Acute painful situations, hospitalized patients Metastatic CA, arthritis Osteoporosis, autoimmune |
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