Exam 2 - Fall Flashcards
(143 cards)
1
Q
scoliosis is a persistent lateral curvature of =
ddx =
A
> 10 degrees on standing xray
> 10 degrees radiographically by Cobb (L)/Ferguson (R) methods
2
Q
curvatures in what gender are more likely to progress and produce symptoms?
A
females
3
Q
type I dysfx maintained by:
A
long paraspinal restrictor M
4
Q
name the scoliosis:
A
name for direction of ratation: convexity
levo: left scoliosis: convex left
dextro: right scoliosis: convex right
5
Q
types of scolosis curves: fx v structural
A
fx: straighten when SB
struct (fixed): does NOT straighten when SB
6
Q
transitional points of curves
apex:
crossover point:
A
apex: max rotation – where R mechanics change
crossover point: joining of 2 curves – where SB mechanics changes
*** places were type II SD found
7
Q
a gorup curve ______ existing spinal kyphosis/lordosis
A
increases
8
Q
at a crossover point, the existing AP curve is ________
A
decreased
9
Q
fryette’s 2nd principle
A
SB intro into non-neutral spine, bodies of vert will R to side of concavity (same SB & R)
10
Q
type ___ lesions should be treated first
A
II
11
Q
type II curves are mainted by:
A
short restrictors: rotatores brevis & intertransversari M
12
Q
type II SD occurs as a result of
ddx from type I?
A
trauma/abrupt twisting
type I: chronic
13
Q
apical type II SD reflect a ________ in AP curves
ex?
A
increase:
flex @ thoracic
ext @ lumbar
14
Q
difference of segments above and below apex?
A
above apex: SB & R in same direction
- upper half of curve behaves as a series of type II dysfx
apex & below: SB & R in opposite directions
15
Q
progression of idopathic scoliosis & associated pain
A
begin: fx curve (no pain)
late adolescence: structral ( no pain - able to compensate)
adult–> middle age: segments adjacent to restricted areas become painful due to mechanical stress of compensation
- found @ crossover points above & below fixed curve
16
Q
classification of scolosis (4)
A
- reversibility
- severity
- location
- etiology
17
Q
Classification: Severity of scoliosis
A
mild: 5-15
mod: 20-45
- >30 should be tx
- >5 degree profession = indication to tx
severe: >50
- >50 compromises respiratory fx
- >70 compromises CV fx
18
Q
Classification: Location of scoliosis
A
19
Q
A
20
Q
etiologies of scoliosis
A
idiopathic: most common
congenital: most of progressive
acquired:
- osteomalacia
- inflammation
- irradiation
- psoas syndrome
- heald leg fx –> short leg
- hip fx/prosthesis –> short leg
21
Q
what is the most common cause of type I group mechanics?
A
unequal leg length –> sacral base unleveling
22
Q
infantile scoliosis
A
non-wt bearing
due to intra-uterine position: intraosseus occipital dysfx:
- asymmetric compression of condylar parts
- torsion of SBS
- compensatory scoliosis from above downwards
becomes apparent by birth–>age 3
23
Q
myopathic scolosis is due to
A
asymmetric strength
musc dystrophy
24
Q
neuropathic scoliosis is due to
A
- polio
- cerebral palsy
- spinal tumors
- von recklinghausen’s neurofibromatosis (AD)
25
CT dysfx causes of scoliosis
congenital
* marfan
* dwarfism
* Ehler-danlos
acquired:
* juvenile RA
26
indications for scoliosis tx
scoliosis \> 20 & progression of \>5 degrees in over 5-6 months
27
OMT infantile scoliosis
cranial: condylar decompression & SBS tx
28
what device can be used to reduce lumbosacral stress in scoliosis?
heel lifts
29
braces are used for what type of scoliosis?
moderate
30
sx for scoliosis
harrington rods & spinal fusion
for progressive 45-50 degree curves to prevent cardiac & pulm compromise
31
short leg syndrome
**actually:** sacral base unleveling
compensation producing lateral spinal curves:
* fx type I
* most common: caudal curve with convexity on same side as low sacral base
32
what is the 1st structure to react to added stress in lumbosacral region?
iliolumbar ligament: point of max tenderness --\> refer to groin
33
sacroiliac ligaments on convex side of short leg may refer pain down
lateral leg
34
OMT ______ definite postural dx (before or after)
why?
**BEFORE**: correct sacrum, innominate, QL
physical diagnosis measurements are OFTEN inaccurate
35
tx short leg syndrome
heel lift of side of depressed sacral base
"fragile" pt: start with 1/16 in lift & increase every 2 weeks
flexible spine: start with 1/8 in lift & increase every 2 weeks
36
suprasternal notch lies anterior to the vertetral body of
T2
37
angle of louis landmark
anterior to T4
aortic arch superior
tracheal bifurcation posterior
38
functional landmarks:
spine of the scapula:
inferior angle of scapula
iliac crest:
T3
T7
L4/L5 interspace
39
thoracic disc hernation can lead to what with cord compression?
bladder and/orbowel incontinence
40
thoracic discogenic pain
| (dermatome map)
dull, radiating chest wall or abdomen pain @ lvl of existing nerve root (lateral disc hernation)
41
efferent SNS synapse @ ______ before target organ
paravertebral ganglia, located anterior to articulation of rib with vertebra
42
to tx synpathetic ganglion, you need to treat \_\_\_\_\_\_\_
both the vert & rib
43
neural model: autonomics
## Footnote
T1-4:
T1-6:
T5-9:
T10-11:
T12-L2
T1-4:
* SNS head & neck
T1-6:
* heart & lungs (left ventricular problems --\> left palp findings)
T5-9: celiac plexus
* R: liver, gallbladder, duod, head of panc
* L: stomach, spleen, tail of panc
T10-11: superior mesenteric plexus
* rest of small intestines, kidneys, upper ureter, gonads (ovary, testes)
* R: appendix, cecum, ascending to mid-transverse colon
T12-L2: inferior mesenteric plexus
* mid-transverse colon to rectum, pelvic organs (bladder, uterus, prostate)
44
segmental facilitation
somatic changes produced by viscerosomatic reflex stimulate local nociceptors --\> positive feedback to dorsal horn --\> amplify & exacerbate body's response to disease & interfere with recoery process
45
Spinal Motion in Breathing
L: inhalation
R: exhalation
46
caliper motion
ribs 11 & 12
move posterior & down on inhalation
47
primary musc of inhalation
primary:
* diaphragm: attach to lower ribs & sternum crura & L1-L3
* external intercostals
accessory:
* SCM
* scalenes
48
muscles of exhalation
primary:
* passive process!
* forced expiration: internal intercostals
accessory:
* rec abd
* internal/external oblique
* tx abd
49
how do you get these conditions?
a) Pigeon chest (pectus carinatum) – the sternum projects forward and downward (congenital).
b) Funnel chest (pectus excavatum) – the sternum pushed posteriorly by an overgrowth of the ribs (congenital).
c) Barrel chest – the sternum projects forward and upward, AP diameter is increased (pathological conditions, such as emphysema, COPD).
50
kyphotic deformities:
## Footnote
ankylosing spondylitis:
pott's disease:
round back:
hump back:
flat back:
dowager's hump:
ankylosing spondylitis:
* bekhterev's disease
* forward head, flat chest, lumbar lordosis, abdomen protrusion
pott's disease:
* TB of spine
round back:
* pelvic incline of 20 deg
hump back:
* gibbus deformity
* anterior wedge of body of 1-2 vert, pelvic incline @ 30 deg (normal)
flat back:
* pelvic incline @ 20deg (decr), similar to round back except thoracic spine mobile
dowager's hump:
* postmenopause osteoporosis
* anterior wedge fx, scoliosis
51
this is showing:
wedge fx
52
both R & L lymphatic ducts are invested in \_\_\_\_\_\_
what and where do they drain?
sibson's fascia of the thoracic inlet
IJV & SC
53
the diaphragm attaches at:
xiphoid
inferior 6 ribs
L1-3
54
is osteoporosis a C/I to OMM?
yes
55
Scheuermann's disease
juvenile osteochondrosis of spine
"sherman's disease, scheuermann's kyphosis, calve disease"
childhood: improper dev & wedging of vert bodies
self-limiting: will not progress once skeletal mature
* symptoms last 6mo - 3 years
56
scheuermann's disease tx:
brace/casting
sx: rare (if greater than 75 degrees & unresponseive to other measures --\> spinal fusion)
57
PNS ganglion:
CN III, VII, IX, X
* head, cervical, thoracic, abdominal organs up to splenic flexure
S2-S4
* remaining GI, pelvic viscera
**craniosacral**
58
heart & lung SNS lvls (more precise)
heart: T1-5/6
lung: T2-7
59
SA & AV nodes are supplied by which side of SNS/PNS?
SA: R SNS & Vagus
AV: L SNS & Vagus
60
visceral afferents from below the pelvic pain line follow PNS or SNS?
PNS
61
accessory M use during pulmonary disease produce symptoms in what locations?
neck & UE
62
prevertebral fascia
occiput/sphenoid/mandible --\> diaphragm
63
pretracheal fascia
cranial base --\> percardium roots of major vessels, pleura, mediastinum --\> diaphragm
64
vagus nerve
origin: cell bodies in medulla & floor of 4th ventricle
course: jugular foramen b/w occiput & temporal bone
exit: C2 body
65
pleura is innervated by \_\_\_\_\_\_\_
therefore, if pleura is invlved, the palpable refelx will be \_\_\_\_\_\_\_
innervated by: GSA (gen somatic afferent)
reflex: segmental @ site of pleural involvement and true reflex will be palpated @ upper thoracic area
66
chapman's reflex location for lower lungs
4th ICS adjacent to sternum (anterior)
b/w SP/TP of T4/T5 (posterior)
67
68
vagus parasympathics are located:
OA & C2
69
FPR
indirect passive myofasical release (pt does nothing & engage the freedoms of motion)
decrease M hypertonicity
70
physiology of FPR
compression of M into more than neutral position will **quiet** gamma gain by eliminating excitatory inpur of group Ia/II fibers --\> reduction of stretch stimuli & elimation of reflex activation of alpha motor neuron
71
principles of FPR
activating force applied:
* compression (most common)
* traction
* torsion
3 F's: flatten, faciliation, freedoms
72
FPR contraindications:
relative:
* herniated disc
* foramen stenosis
* vertebrobasilar insufficiency
* severe sprains/strains
* tx across wounds
absolute:
* joint instability
* fx/mets/inflammation/infetion
* hip prosthesis
73
long term SNS hypertonic effect on goblet cells
increase in #
make thincker, stickier, more tenacious mucus
74
level of diaphragm during expiration & inspiration
expiration: 4th ICS
inspiration: 6th ICS
75
diaphragm mvmt: resting v deep inspiration
resting: 2cm
deep inspiration: 9-10 cm
76
restrictive v obstructive lung disease
restrictive: low lung vol (TLC & FVC)
obstructive: decrease in expiratory flow rates & increase in lung vol (RV)
77
SNS innervation to repiration orginate from which ganglion?
middle & superior cervical
stellate
upper thoracic paravert chain ganglion
78
viscerosomatic reflex in resp pt occur most commonly @
C3-4 & T2-9
79
locked up v locked down ribs
locked up:
* obstructive lung disease
* M: SCM, s. anterior, scales, external intercostals
* decreased thoracic kyphosis
locked down:
* restrictive
* M: internal intercostals
* increased thoracic kyphosis: flexion lesions
80
emphysema (8)
pink puffer
pursed lips: produce resistance preventing alveolar collapse
hyperthrophy of scalenes & SCM
elevated 1st rib
more acute angle of louis
barrel chest: ribs in upper position - inhalation dysfx/exhalation restriction
freq sit with arms up on table: pec M use to move upper rib cage
hyperinflated lungs
81
chronic bronchitis
blue bloated
sunken chest
musuc thickening --\> poor diffusion
ribs in upper position
82
what muscles assist in maintainig inhalation dysfx?
SCM & anterior scalene
involved in 1st fib of cervical (C7/C8) points
pump motion
83
during an astham attached, it is harder/longer to breathe \_\_\_\_
out --\> air trapping
84
paranasal sinus & drainage pattern
located in: maxillary, frontal,sphenoid & ethmoid bones
drainage:
anterior ethmoid, frontal, maxillary --\> middle turbinate
posterior ethmoid, sphenoid --\> sphenoethmoid recess
85
OMT for sinusitis (5)
1. suture & membrane restriction: spheno-petrosal, pterygopalatine, fronto-ethmoid
2. CV4 hold: enhance CSF flow
3. galbreath technique: enhance retromand drain & sphenopalatine gang (PNS) fx
4. supra & infra-orbital inhibition of SNS sphenopalatine (pterygopalatine) gang
5. effleurage
86
87
suboccipital release
88
CV4 hold
89
OA distraction
90
sphenopalatine ganglion technique
91
Inhibition of sympathetic fibers of pterygopalatine ganglion
92
Bitemporal Roll to Release Dysfunctional Eustachian Tubes
93
lymph pump
94
pec traction
95
pedal pump
96
dome of diaphragm
97
hyoid & trachea mobilization
98
cerv lymph drainage
99
rib raising
100
rib raising
101
direct springing thoracic spine
102
FPR CLAVICLE
103
Myofascial Cervical Spine
104
myofascial release of thoracic inlet (sibson's fascia)
turning a driving wheel
105
sympathetic inhibition
inhibit paraspinal region until feels release
106
visceral v somatic pain
visceral:
* poorly localized
* deep
* midline
* vague
* often referred
somatic:
* localized to skin, m, bone
* lateralized
* clearly described
107
visceral nociceptors are most senstive to:
stretch
hollow organs produce more pain
108
spinothalamic tract
carries both visceral & somatic info
* tract a: cutaneous
* c: only visceral
* b: both --\> brain interprets visc nociception as skin/muscle pain (of assocaited dermatone/myotome)
109
levine's sign
clenched fist held over the chest to describe ischemic chest pain
110
Visceral Pain Referral Patterns
111
bainbridge effect
stretch of atria stimulates increased speed & strength of contraction
112
excessive stretch of stomach cantrigger:
SNS refelx to cease churning and secretion
113
endothroacic fasica
invests M of thoracic cage
blends with periosteum of ribs & sternum
ex: pericardium, pleura, mediastinum
**strain from abdomen/diaphragm to cranial base will affect form and fx of whole thorax**
114
Pectoralis Trigger Points
115
rib motions
upper: pump
lower typical: bucket
middle ribs: combo pump & bucket
rib 11 & 12: caliper
116
Pump-handle Rib Mechanics
117
Bucket-handle Rib Mechanics
118
Caliper/pincer Rib Mechanics
119
neurovascular bundle and lymphatics sandwiched b/w which intercostal M?
internal & innermost
VAN (top to bottom) in costal groove (bottom of rib)
120
costochondritis
common
mainly women in 40s
3-5 costochondral joints
sometimes has referral down arm
always benign
121
tietze's syndrome
rare
affects men and women equally
affects **single rib**: 2nd or 3rd
often has referral pain down arm
can be due to malignancies
122
Osteopathic Treatment of Non-Cardiac Chest Pain
1st: viscero-somatic
2nd: chapman's reflexes
123
prevertebral fascia blends with the ____ @ \_\_\_\_
blends with the anterior longitudinal ligament at the level of T3.
124
pretacheal fascia descends the thorax to fuse with....
fibrous percardium
125
lymphatics from the heart primarily drain by the ____ lymphatic duck
right
126
sympathetic cell bodies originate:
1st-6th thoracic cord segments
127
symphathetic cervical ganglion
superior:
* anterior to TPs of C2-3 --\> cardiac branch
middle:
* anterior to TPs of C5-6 --\> cardiac branch
inferior (stellate):
* b/w Tp of C7 & neck of 1st rib
128
sympathetic ganglia are enveloped in \_\_\_\_\_\_\_and are _______ to rib angles
Sympathetic ganglia are enveloped in **endothoracic fascia**, and are **anterior** to the rib angles.
129
inferior wall MI --\>
interrupted blood supply of R coronary artery --\> AV node
commonly associated with GI symptoms
**very close to vagal fibers** --\> bradyarrhythmias & heart block
130
which ganglia post MI is a source of ventricular arrythmias?
left stellate ganglia
131
which trigger point can cause SVTs?
right pec major trigger point b/w ribs 5-6
b/w sternal margin & nipple line
132
the still technique
OMT characterized as specific, non-repetitive articulatory method that is indirect then direct, utilizing a vector force
## Footnote
vector: point at restrcited segment in 3D
moving force that changes as dysfx changes
\<5 lbs
traction or compression are most common forces applied
133
engagement of the barrier using the still technique is often times paired with....
a palpable or audible "click" as the golgi tendom gets engaged
134
still technique v FPR
still: position of ease more exaggerated than FPR's "neutral"
still: requires mvmt of affected tissue from ease through restriction (FPR does not engage barrier, only freedoms)
135
post-OMT reaction
frequently, pts experience post-tx myalia usually occuring within 1st 12 hours after tx that can last for a day
discomfort is similar to a vigorous workout
recommendation: nsaids, hot shower, increased flud intake
136
137
most common cause of heart failure =
CAD
138
this is a classic CXR of...
CHF
139
kerley b blines
fine horizontal opacified lines representning pulm edema
140
medial and lateral arcuate ligaments of the diaphragm cover which M?
psoas
QL
141
what can have greater influence on cardiac excitability than that of circulating adrenal catecholamines?
stellate ganglion
142
right stellate ganglion v left effects
right: increases inotropic (contractility) & chronotropic (rate);
left: inotropic only
143
vagal effects of SA & AV node
SA: sinus brady & asystole
AV: heart block
