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OPP 1 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What 3 bones make up the “innominate” bones?

A

Ilium
Ischium
Pubic Bone

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2
Q

What are some key features of the sacrum?

A

5 fused segments
Coccyx - 4 fused segments
- Lumbosacral facets: facing medial, superior

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3
Q

What is special about the Lumbosacral junction?

A

May contain transitional vertebrae

i.e. sacralization or lumbarization

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4
Q

Sacralization of L5

A

Fusion of L5 and first sacral segment

Occurs in 3.5% of population

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5
Q

Lumbarization of S1

A

First sacral segment doesn’t fuse with the rest of the sacrum

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6
Q

Ferguson angle

A

Lumbosacral angle - line of inclination of sacrum with line parallel to ground
Should be 25-35 degrees
- Sacroiliac joint is L-shaped and converges posteriorly
- Moving forward increases the angle

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7
Q

Which muscles attach directly from the sacrum to the ilium?

A

There aren’t any direct muscular attachments from sacrum to ilium

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8
Q

What is sacral motion?

A

A function of forces acting on the sacrum

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9
Q

What are the true pelvic ligaments?

A

Anterior sacroiliac
Interosseous
Posterior sacroiliac

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10
Q

Accessory pelvic ligaments

A

Sacrotuberous
Iliolumbar
Sacrospinous

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11
Q

What is the function of the true pelvic ligaments?

A

Retrain posterior, lateral, and axial rotation

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12
Q

What is the function of the accessory pelvic ligaments?

A

Restrain anterior movement and rotation, also have a role in vertical stability

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13
Q

Sacral plexus

A

Contains both motor and sensory nerves for the pelvis, lower extremity

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14
Q

Nerve roots of sacral parasympathetics

A

S2,3,4

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15
Q

Ganglion Impar

A

Where the right and left sympathetic chains join and rest on the anterior surface of the coccyx

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16
Q

Transverse axes of rotation of sacrum

A

Superior
Middle
Inferior

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17
Q

Superior axis of sacrum

A

S2 segment, posterior to Sacroiliac joint

- Respiration, craniosacral motion

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18
Q

Middle axis of sacrum

A

Located at anterior convexity of upper and lower limbs of SI joint at S2 sacral body
- Postural flexion and extension
aka Sacroiliac axis

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19
Q

Inferior axis of sacrum

A

Posterior inferior part of the inferior limb of the SI joint
- Ilial (innominate) rotation

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20
Q

Oblique axes of the sacrum

A

Right and left
Most likely a combination of 2 motions: side-bending and rotation
- Named from the top (i.e. left moves diagonally from top left to lower right)

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21
Q

Types of sacral motion

A 
Postural:
 - flexion/extension
 - rotation
 - sidebending
 - torsion
Inherent
Respiratory 
Dynamic
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22
Q

Flexion/extension of sacrum

A

In anatomical flexion the base of the sacrum moves anteriorly

  • Movement is about the middle transverse axis
  • Extension - moves posteriorly
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23
Q

Rotation of the sacrum

A

Occurs about a vertical axis

- More of a theoretical consideration

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24
Q

Sidebending of sacrum

A

Occurs about an Anterior-Posterior axis

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25
Q

Standing flexion test

A

Gross evaluation of iliosacral motion
Patient is standing, feet shoulder width apart
- Operator behind pation with thumbs under the PSIS
- Patient bends forward
-Motion restriction: PSIS moves cephalad on side of dysfunction

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26
Q

Seated flexion test

A
  • Evaluates sacroiliac dysfunction (sacrum is primary cause)
  • Patient is seated
  • Operator behind patient, eyes level, thumbs under PSIS
  • Same as standing (cephalad movement indicates motion restriction), but removes innominates as a factor
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27
Q

Spring test

A

Tests for forward torsions
- Patient is prone, heel of hand on lumbosacral junction
Gentle but rapid force applied downward

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28
Q

Negative spring test

A

Good spring at lumbosacral junction - this is normal

- forward torsion or uni/bilateral sacral flexion

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29
Q

Positive spring test

A

Poor spring at lumbosacral junction - sacrum is posterior

- Backward torsion, uni/bilateral sacral extension

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30
Q

Forward Sacral Torsions

A

Flexed
Left on Left
Right on Right

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31
Q

Backward Sacral Torsions

A

Extended
Left on Right
Right on Left

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32
Q

Left on left sacral torsion

A

Deep sulcus on right
Inferior/Posterior ILA: left
Seated flexion test: + on right
Spring test: negative

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33
Q

Right on right sacral torsion

A

Deep sulcus on left
Inferior/posterior ILA: Right
Seated flexion test + on left
Spring test: negative

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34
Q

Left on right sacral torsion

A

Deep sulcus: right
Inferior/posterior ILA: Left
Seated flexion: + left
Spring test: positive

35
Q

Right on left sacral torsion

A

Deep sulcus: left
Inferior/posterior ILA: Right
Seated flexion test: + Right
Spring test: positive

36
Q

Unilateral Sacral flexion

A

Spring test is negative

Deep sulcus, inferior/posterior ILA, seated flexion test + on side same as named dysfunction

37
Q

Right unilateral sacral extension

A

Positive seated flexion test on right

  • Right sacral sulcus shallow, right sacral base posterior
  • Right ILA will be mildly anterior, significantly superior
  • Positive spring test
  • Positive sphinx test
38
Q

Bilateral sacral flexion

A

Motion decreased bilaterally
- Sacrum flexes but is restricted in extension
- Spring test - negative
Seated flexion positive bilaterally

39
Q

Bilateral sacral extension

A

Motion is decreased bilaterally
- Sacrum extends but is restricted in flexion
Spring test is positive

40
Q

In what year was A.T. Still born?

A

1828

41
Q

When did A.T. Still fling “the banner of osteopathy to the breeze”?

A

June 22, 1874

42
Q

When did the American School of Osteopathy open in Kirksville?

A

1892

First graduating class - 1893

43
Q

When was the death of A.T. Still?

A

1917

44
Q

When was “The California Experience”?

A

1961

45
Q

What are the functional units of the cervical spine?

A

Unit 1: occiput, atlas, axis

Unit 2: cervicals C3 to C7

46
Q

Superior facets of the atlas

A

Face backward, upward and medially

Concave

47
Q

Occipital condyles

A

The sphere
Match the facets of the atlas
Essentially a ball in a cup

48
Q

What is the most important/most clinically significant somatic dysfunction which should be addressed in newborns?

A

Occipital condylar compression
Affects cranial nerves IX, X, XI; can be cause of poor suck, swallowing difficulties, emesis, hiccups, congenital torticollis, perhaps pyloric stenosis

49
Q

Primary motion of occipital-atlantal joint

A

Flexion/Extension
Flexion: posterior translatory slide
Extension: anterior translatory slide

50
Q

Lateral atlanto-occipital ligament

A

Sidebending and rotation always in opposite direction

Occiput rotates left on axis, occiput slides left and side bends right

51
Q

Atlantoaxial joint

A

Rotation - nearly pure (no true flexion)
4 facets - all convex in shape, wobble in flexion/extension
- No true lateral flexion
Somatic dysfunction occurs in rotation

52
Q

How is cervical spine dysfunction described using Fryette’s principles?

A

Often described as Type I mechanics - sidebending and rotation are most often to opposite sides

  • Fryette never wrote about the cervical spine
  • Fryette’s laws of motion are based upon the physical features of the thoracic and lumbar vertebrae
53
Q

Movement in atlantoaxial rotation

A

Movement (except rotation) limited by odontoid process (dens) and transverse ligament of atlas
- Rotation to right: left facet of atlas slides uphill; right facet of atlas slides downhill

54
Q

Suboccipital articulation

A

A combination of occipitoatlantal and atlantoaxial joints

Functionally - universal swivel joint

55
Q

Final compensator of the spine

A

Suboccipital articulation

  • Keeps eyes level
  • Promotes binocular vision
  • C2-C3 sustains tremendous stress between final compensator and rest of spine (common location of chronic somatic dysfunction)
56
Q

C3-C7 intervertebral discs

A

Thickest of spinal disks
Disk height:vertebral body ratio is 2:5
- wedge-shaped, thicker anteriorly, maintains flexible cervical lordosis

57
Q

C3-C7 Facet joints

A

Form palpable articular pillars

  • superior face backward/up
  • inferior face forward/downward
  • Rotation and side bending coupled in the same direction
58
Q

C3-C7 Motion

A

Move least in flexion/extension
Flexion - forward bending - inferior facet must slide up 45 degree angle
- Rotation is primary motion
Extension - backward bending
- normal lordotic curve, side bending is primary motion
There is no “neutral” position

59
Q

How are vertebrae C3-C7 described using Fryette’s principles?

A

Often described as Type II mechanics because sidebending and rotation are most often to the same side

60
Q

Joints of Luschka

A

aka Unciform Joints

  • Maintain stability while allowing motion
  • Specialized sets of synovial joints
  • Adaptation for upright posture
  • Lateral edges of cervical vertebral bodies
  • Develop at age 8-10 years
61
Q

Function of Joints of Luschka

A

“Guide rails” for flexion/extension

  • Limit lateral translatory motion (side slip)
  • Occurs with coupled motions of rotation and side bending, would be excessive to point of subluxation if not for unciform joints
62
Q

Side slip

A

Complicated somatic dysfunction resulting from dysfunction of translatory motion

63
Q

Cervicothoracic junction

A

Transitional segments - cervical traits superiorly, thoracic traits inferiorly

  • cervical lordosis ends and thoracic kyphosis begins
  • Complex forces
  • Somatic dysfunction is common and difficult to treat
64
Q

Articular pillars

A

aka lateral masses of cervical vertebrae

  • Area between cervical facet joints
  • True transverse processes are the anterior and posterior tubercles
65
Q

Anterior component

A

Positional descriptor used to determine the side of reference when rotation of a vertebrae has occurred
- Usually refers to the less prominent transverse process

66
Q

Posterior component

A

Positional descriptor used to determine the side of reference when rotation of a vertebrae has occurred
- Usually refers to the more prominent transverse process

67
Q

How would you diagnose TART changes in the cervical vertebrae?

A

Stand at head of table

  • Palpate along articular pillars
  • Identify muscle hypertonicity and tissue change that is asymmetric
  • Proceed from superficial to deep (deep palpation will alter superficial tissue qualities)
  • Describe findings including location and quality
68
Q

Motion of occiput

A

Major motion is flexion/extension

Minor motions are rotation and sidebending

69
Q

Lateral translation test of occiput finds right posterior occiput

A

translates freer to right

  • Occiput is side-bent left and rotated right on atlas
  • Right OA joint will not move anterior in extension
  • Right OA has palpable tissue texture changes
70
Q

Lateral translation test finds left anterior occiput

A

Occiput is sidebent left and rotated right on atlas
Left OA joint will not move posterior in flexion
- Left OA joint has palpable tissue texture change and is tender

71
Q

Diagnose - an occiput that sidebends left and rotates right

A

Either posterior right or anterior left

72
Q

Diagnose: an occiput which sidebends right and rotates left

A

Either posterior left or anterior right

73
Q

Motion testing of atlas

A

Rotation is major motion

  • flex entire cervical spine to lock out C2-C7 - patient is supine, limits rotation to atlas
  • Palpate lateral masses
  • Rotate head both ways
  • Use nose or chin as pointer to compare degrees of free motion
  • Name direction of freer motion
74
Q

Motion testing of cervical segments C2-C7

A

Rotation and sidebending to same side for single segmental dysfunction

  • Palpate articular pillars (patient supine)
  • Introduce extension to localize segment
  • Rotate cervical spine accumulating force at segment - name for freer motion
  • Translate segment - note freer motion
  • Test rotation/sidebending in flexion/extension - name freer motion
75
Q

What is almost always associated with suboccipital symptoms, tension, and tissue change?

A

Upper thoracic and rib problems on the same side

  • treat upper thoracic area first
  • test the suboccipital area before and after treatment of upper thoracics will reveal a significant decrease in suboccipital findings
76
Q

What is chronic dysfunction in the cervical area often associated with?

A

Chronic dysfunction in the sacral area

  • Dural connections - suboccipital regions (C0, C1, C2) and sacral base/L4,L5
  • Treatment of both areas may be necessary to prevent reoccurrence
77
Q

Benign cervical vertigo

A

Temporal bone has muscular ties to cervical region

  • Cervical spasm causes temporal bone asymmetry
  • Vestibular asymmetry - vertigo
78
Q

What allows dysfunctions to be propagated through the head and neck?

A

Gear-like cranial mechanism

79
Q

Which muscles are usually involved in acute neck problems?

A

Cervical prevertebral muscles

i. e. Scalenes, longus group
- gross cervical motion testing will reveal restriction of rotation and sidebending to same side

80
Q

Rotation and sidebending in sternocleidomastoid shortening

A

Occur to opposite sides

81
Q

Whiplash

A

Acute extension trauma
Injury to flexor muscles - take prolonged time to treat
- Counterstrain, indirect, fascial release, cranial - appropriate initially
- Look for an extended upper or mid-thoracic somatic dysfunction as part of injury
Treat: thoracics, then suboccipital, then neck

82
Q

What technique is used to treat acute cervical muscle spasms?

A

Muscle energy technique

  • Head positioned in midpoint of pain free motion, held by physician
  • Patient turns head toward restriction
  • Relax, turn further toward restriction, repeat to increase range of motion
  • Barrier is not engaged - neither direct nor indirect technique
83
Q

Cervical root irritation

A

Irritation or compression from osteophyte or disc
- Diagnose by careful neurological testing
6th root - innervates thumb
- Sensory loss and motor weakness with decreased deep tendon reflexes
- Irritation may be intermittent and insufficient to produce neurologic deficit

OPP 1 (3 decks)

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