Cervical superior facet orientation?
Backward, upward, medial
Thoracic superior facet orientation?
Backward, upward, lateral
Lumbar superior facet orientation?
Muscle contraction that results in tension remaining the same while muscle length shortens; operator's force is less than patient's force
Muscle contraction that results in the increase in tension without a change in muscle length; operator's force is equal to patient's force
Muscle contraction against resistance while forcing the muscle to lengthen; operator's force is more than patient's force
Muscle contraction that results in the approximation of the muscle's origin and insertion
Lengthening of muscle during contraction due to an external force
Direct and indirect, active and passive
Facilitated positional release?
Direct and indirect, passive
In type I dysfunction, what motion precedes what?
SB precedes rotation (OSR)
In type II dysfunction, what motion precedes what?
Rotation precedes SB (TRS)
What is the only subjective component of TART?
2 types of isotonic contraction?
1) Concentric (shortening)2) Eccentric (lengthening)
Upward mvt of a bicep curl?
Downward mvt of a bicep curl?
Contraction in which tension remains the same?
Which vertebra has no spinous process or vertebral body?
Which vertebrae have bifid spinoud processes?
What portion of the cervical vertebrae lies bt the superior and inferior facets?
Articular pillars (or lateral masses)
What is located posterior to the cervical transverse processes?
What is used by DO's to evaluate cervical vertebral motion?
What vertebrae do the vertebral arteries pass thru?
What do the vertebral arteries pass thru?
Where do the scalenes originate?
Posterior tubercle of the transverse processes of the cervical vertebrae
Where does the anterior scalene insert?
Where does the middle scalene insert?
Where does the posterior scalene insert?
What are the actions of the scalenes?
Sidebend to same side with unilateral contraction, flex with bilateral contraction (also aid in respiration)
Where would you find a scalene tenderpoint in a rib dysfunction?
Posterior to clavicle at base of neck
Where does the SCM originate?
Mastoid and lateral half of superior nuchal line
Where does the SCM insert?
Medial 1/3 of clavicle and sternum
What are the actions of the SCM?
With unilateral contraction, will sidebend ipsilaterally and rotate contralaterally; bilateral contraction flexes head
Shortening or restrictions within the SCM results in what?
What ligament extends from the sides of the dens to the lateral margins of the foramen magnum?
What ligament attaches to the lateral masses of C1 to hold the dens in place?
Transverse ligament of the atlas
What syndromes can weaken the alar and transverse ligaments resulting in AA subluxation?
Down's and RA
What are uncinate processes?
Superior lateral projections originating from the posterior lateral rim of the vertebral bodies of C3-7
What is the joint of Luschka (unconvertebral joints)?
The articulation of the superior uncinate process and superadjacent vertebrae
What is the most common cause of cervical nerve root pressure?
Degeneration of the joints of Luschka plus hypertrophic arthritis of the intervertebral synovial (facet) joints
Where does C8 nerve root exit?
Between C7 and T1
What nerve roots make up the brachial plexus?
What is the primary motion of the OA?
Flexion and extension--50% of flexion/extension of cervical spine occurs at OA
How does sidebending occur at OA?
What is the primary motion of the AA?
Rotation--50% of rotation of cervical spine occurs at AA
What are the mvts of C2-7
Sidebending and rotation occur to the same side
Main motions of C2-4?
Main motions of C5-7?
Lateral translation to the right will cause what motion?
What if you feel a deep sulcus on the right at the OA joint?
Rotated right, sidebent left
How do you evaluate the AA?
Flex cervical spine to 45 degrees to lock out rotation of typical cervical vertebrae
An acute injury to the cervical spine is best treated how?
MFR or counterstrain
How does cervical foraminal stenosis present?
Neck pain radiating to upper extremity
What are the S/S of cervical foraminal stenosis?
Increased pain with neck extension, posiive Spurling's, paraspinal muscle spasm, posterior and anterior cervical tenderpoints
Which vertebra actually rotates, the atlas or axis?
Atlas rotates on axis
Which cervical segment is best assessed by flexing neck to 45 and rotating?
T1-3 rule of 3's?
SP is located at level of corresponding TP
T4-6 rule of 3's?
SP is located one-half a sefment below the corresponding TP
T7-9 rule of 3's?
SP is located at level of TP of vertebrae below
Follows same rules as T7-9?
Follows same rules as T5-7?
Follows same rules as T1-3?
Spine of scapula is at what level?
Inferior angle of scapula corresponds with what?
Spinous process of T7
Sternal notch is at what level?
Sternal angle (angle of Louis) attaches to which rib and what level is it?
2nd rib, level of T4
What is the main motion of the thoracic spine?
Upper and middle thoracic spine motion?
Rotation > flexion/extension > SB
Lower thoracic spine motion?
Flexion/extension > SB > rotation
Primary muscles of respiration?
Rib attachments for diaphragm?
Ribs 6-12 b/l
Vertebral attachments for diaphragm?
Anterior attachment for diaphragm?
Action of intercostal muscles?
Elevate ribs during inspiration and prevent retractions during inspiration
Secondary muscles of respiration?
Scalenes, pec minor, serratus anterior/posteiror, quadratus lumborum, latissimus dorsi
What makes a typical rib typical?
Contains Shaft, Head, Angle, Neck, Tubercle (SHANT)
What is the difference bt head and tubercle of rib?
Head--articulates with vertebra above and corresponding vertebra; tubercule--articulates with corresponding TP
1, 2, 11, 12 (ribs with "1" and "2"), sometimes 10
Reason why rib 1 is atypical?
Articulates only with T1 and has no angle
Reason why rib 2 is atypical?
Has large tuberosity on shaft for serratus anterior
Reason why ribs 11 and 12 are atypical?
They articulate only with corresponding vertebrae and lack tubercles
Reason why rib 10 may be atypical?
May articulate only with T10
1-7 (attach to sternum thru costal cartilages)
8-12 (connected by its costal cartilage to the cartilage of the rib superior)
Pump handle, bucket handle, caliper
Move primarily in pump handle?
Move primarily in bucket handle?
Move primarily in caliper?
Ribs 11 and 12
Rib appears to be "held up", will not move caudad?
Rib appears "held down", will not move cephalad?
Rib elevated anteriorly?
Pump handle inhalation dysfunction (depressed anteriorly for exhalation dysfunction)
Rib elevated laterally?
Bucket handle inhalation dysfunction (depressed laterally for exhalation dysfunction)
Anterior narrowing of intercostal space above dysfunctional rib?
Pump handle inhalation dysfunction (opposite for exhalation dysfunction)
Lateral narrowing of intercostal space above dysfunctional rib?
Bucket handle inhalation dysfunction (opposite for exhalation dysfunction)
Superior edge of posterior rib angle is prominent?
Pump handle inhalation dysfunction (opposite for exhalation dysfunction)
Lower edge of rib shaft is prominent?
Bucket handle inhalation dysfunction
What is the key rib responsible for group inhalation dysfunctions?
What is the key rib responsible for group exhalation dysfunction?
Where is tx directed for a group dysfunction?
Reason why lumbar spine is more susceptible to disc herniation?
Narrowing of posterior longitudinal ligament
Comparison of posterior longitudinal ligament at L1 and at L4-5?
Is 1/2 the width at L4-5 than at L1
Location of where spinal cord terminates?
Location of where nerve roots exit in lumbar spine?
Below corresponding vertebrae, but above the IV disc
Origin of iliopsoas m?
T12-L5 vertebral bodies
Insertion of iliopsoas m?
Erector spinae mm from lateral to medial?
Iliocostalis, Longissimus, Spinalis (I Love Spine)
Level of iliac crest?
T10 dermatome at umbilicus is anterior to which IV disc?
Most common anomaly in lumbar spine?
Facet trophism--predisposes to early degenerative changes
What is facet trophism?
Lumbar facet joints are aligned in coronal plane (instead of sagittal)
What is sacralization?
TPs of L5 are long and articulate with sacrum--predisposes to early degenerative changes
What is lumbarization?
Failure of fusion of S1 with other sacral segements
What is spina bifida?
Defect in closure of limina of vertebral segment
3 types of spina bifida?
Occulta, meningocele, meningomyelocele
Alignment of lumbar facets?
Backward and medial for superior facets
Major motion of lumbar spine?
Flexion and extension (small degree of SB, limited rotation)
Sidebending of L5 will cause what sacral motion?
Sacral oblique axis will be engaged on same side
Rotation of L5 will cause what sacral motion?
Sacrum will rotate toward opposite side
Lumbosacral angle--formed by intersection of a horizontal line and the line of inclination of the sacrum (25-35 degrees)
98% of disc herniations occur where?
Between L4-5 or L5-S1
A herniation bt L4-5 will exert pressure on which nerve root?
L5 (the nerve root below)
Positive test seen in disc herniation?
Straight leg raising test
What is relatively CI in herniation?
OMT for herniation?
Initially indirect techniques, then gentle direct
Positive test seen in psoas syndrome?
Tender point seen in psoas syndrome?
Medial to ASIS
Dysfunctions seen in psoas syndrome?
Nonneutral dysfunction of L1-2, positive pelvic shift test to contralateral side, sacral dysfunction on an oblique axis, and contralateral piriformis spasm
When do you stretch psoas m in psoas syndrome?
OMT for psoas syndrome?
Counterstrain to anterior iliopsoas tenderpoint followed by ME/HVLA to high lumbar dysfunction
Causes of spinal stenosis?
Hypertrophy of facet joints, Ca deposits within ligamentum flavum and posterior longitudinal l, loss of IV disc height
Radiology for spinal stenosis?
Osteophytes and decreased IV disc space, foraminal narrowing on oblique views
What is spondylolisthesis?
Anterior displacement of one vertebrae in relation to one below due to fractures in the pars interarticularis
Where does spondylolisthesis occur?
L4 or L5
What are the neuro deficits in spondylolisthesis?
What is a positive vertebral step-off sign?
Palpating the spinous process there is an obvious forward displacement at the area of listhesis
S/S of spondylolisthesis?
Pain with extension-based activities, tight hams b/l, stiff-legged, short stride, waddling gait
Goal of tx for spondylolisthesis?
Reduce lumbar lordosis and somatic dysfunction
What is CI in spondylolisthesis?
Grading for spondylolisthesis?
1 = 0-25%; 2 = 25-50%; 3 = 50-75%; 4 = >75%
What is spondylolysis?
Defect of pars interarticularis WITHOUT anterior displacement of vertebral body
Radiology for spondylolysis?
Scotty dog on oblique view--fracture of pars interarticularis
What is spondylosis?
Radiological term for degenerative changes within IV disc and ankylosing of adjacent vertebral bodies
How do you dx spondylolisthesis vs. spondylolysis?
Spondylolisthesis = lateral x-ray; sponylolysis = oblique x-ray
Cause of cauda equina syndrome?
Massive central disc herniation
S/S of cauda equina syndrome?
Saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel/bladder control
Result of delay in surgery for tx cauda equina?
Epidemiology of scoliosis?
5% of school-aged children develop it before 15
Percentage of children with actual sxs related to their scoliosis?
Female: Male ratio for scoliosis?
Curve that is SB left = scoliosis to the right
Curve that is SB right = scoliosis to the left
2 types of scoliosis curves?
1) Structural curve2) Functional curve
Which curve is fixed and inflexible?
Which curve will NOT correct with sidebending in opposite direction?
Which is assoc with vertebral wedging and shortened ligaments/musccles on concave side?
T/F An uncorrected functional curve may progress to a structural curve?
When should kids be screened?
What is the angle measures the degree of scoliosis?
What is Cobb angle?
Draw horizontal line from vertebral bodies of extreme ends of curve; then draw perpendicular lines from these horizontal lines
At what angle is respiratory function compromised?
At what angle is cardiac function compromised?
What are the causes of scoliosis?
Idiopathic, congenital, neuromuscular, acquired
Which type is most often progressive?
What are Konstancin exercises?
A series of specific exercises that has been proven to improve the pt with scoliotic postural decompensation
When is bracing indicated?
When i surgery indicated?
Severe scoliosis--if there is resp compromise or if it progresses despite conservative management
3 things that cause short leg?
1) Sacral base unleveling2) Vertebral SB and rotation3) Innominate rotation
Most common cause of anatomical short leg?
First ligament to be stressed in short leg?
Iliolumbar ligaments, then the SI ligaments
Sacral base unleveling compensation?
Sacral base will be lower on short leg side
Anterior rotation on short leg side; posterior rotation on long leg side
Lumbar spine compensation?
SB away, rotate toward short leg side
Lumbosacral (Ferguson's) angle compensation?
Increased 2-3 degrees
How to quantify differences in heights of femoral head for short leg syndrome?
When to consider heel lift?
Femoral head difference >5mm
When should the full lift be administered?
Sudden onset of discrepancy (e.g. fracture, surgery)
What should the final lift height be?
1/2 - 3/4 of measured leg length discrpancy
What should the "fragile" pt begin with?
1/16" (1.5mm) and increase 1/16" every 2 weeks
What should the "flexible" pt begin with?
1/8" (3.2mm) and increase 1/8" every 2 weeks
What is the max height that can be applied to INSIDE the shoe?
What if >1/4" is needed?
Apply to OUTSIDE of shoe
What is maximum heel lift possible?
How do you prevent pelvis from rotating to opposite side when >1/2" lift is needed?
Apply an ipsilateral anterior sole lift extending from heel to toe
Most common cause of scoliosis?
When do the 3 bones of the innominate fuse?
20 years old
Anterior portion of 1st segment (S1)?
Top (most cephalad) part
In somatic dysfunctions, what can be recorded as shallow (posterior) or deep (anterior)?
Sacral base or sacral sulci
How can you record the sacral ILA's?
Shallow (posterior), deep (anterior), superior or inferior
The SI joint is an inverted "L" joint with 2 arms converging anteriorly. Where do these arms join?
2 types of pelvic ligaments/
True and accessory
True pelvic ligaments?
Anterior, posterior and interosseous SI ligaments
Accessory pelvic ligaments?
Sacrotuberous, sacrospinous, iliolumbar ligaments
What ligament divides the greater and lesser sciatic foramen?
Which ligament is the 1st to become painful in lumbosacral decompensation?
Types of pelvic muscles?
Primary and secondary
Primary pelvic muscles?
Make up pelvic diaphragm--levator ani, coccygeus
Secondary pelvic muscles?
Iliopsoas, obturator internus, piriformis
Origin/insertion of piriformis?
ILA, greater trochanter
Action of piriformis?
Ext rot, extend thigh, abducts thigh with hip flexed
Innervation of piriformis?
S1 and S2 nerve roots
What are S/S of sciatica due to hypertonic piriformis?
Pain from buttock radiating down thigh but not past knee
Axis upon innominates rotate?
Inferior transverse axis (S4)
4 types of sacral motion?
1) Dynamic motion2) Respiratory motion3) Inherent (craniosacral) motion4) Postural motion
Location of transverse axis for resp and inherent motion of sacrum?
S2 (superior transverse axis)
Craniosacral flexion induces what sacral motion?
Counternutates (rotates posterior)
Craniosacral extension induces what sacral motion?
Nutation (rotates anterior)
Axis during dynamic sacral motion (walking)?
Axis during postural motion?
Middle transverse axis (S3)
When L5 is SB, what sacral axis is engaged and where?
Oblique axis on the same side as side bending
When L5 is rotated, the sacrum rotates which way?
Opposite on an oblique axis
Where is the seated flexion test positive in sacral SD?
Opposite the oblique axis
B/l sacral flexion or extension move around what sacral axis?
What is a common sacral dysfunction in the postpartum patient?
B/l sacral flexion
What axis does the sacrum rotate in a sacral margin posterior SD?
Mid-vertical or parasagittal
What is treated first, L5 or sacrum?
Joints of the shoulder/
Scapulothoracic (pseudo-joint), AC joint, glenohumeral, SC joint
Deltoid (anterior portion)
Lat dorsi, teres major, deltoid (posterior portion)
Primary external rotators?
Infraspinatus, teres minor
Subclavian artery passes bt which 2 muscles?
Anterior and middle scalenes--contracture of these muscles affects arterial supply but not venous drainage
When does subclavian a become axillary a?
Lateral border of 1st rib
1st major branch of brachial a?
Profunda brachial a--accompanies radial n in its posterior course of radial groove
What becomes the deep palmar arterial arch?
Tx technique to relieve lymph congestion of UE?
1) Open thoracic inlet2) Redome diaphragm3) Posterior axillary fold technique
Degrees of motion during arm abduction?
120 degrees due to glenohumeral motion, 60 degree due to scapulothoracic motion
Most common somatic dysfunction of shoulder?
Restriction in internal and external rotation
Least common somatic dysfunction of shoulder?
Restriction in extension
Most common somatic dysfunction of SC joint?
Clavicle anterior and superior on sternum
"Step-off" seen at the AC joint?
Superior and lateral clavicle on acromion
Pathogenesis of supraspinatus tendinitis?
Continuous impingement of greater tuberosity against acromion as arm is flexed and internally rotated
Pain exacerbated by abduction from 60-120 degrees in supraspinatus tendinitis
Aggravating factors in bicipital tenosynovitis?
Elbow flexion or supination
Location of pain in rotator cuff tear?
Tenderness just below tip of acromion
Etiology of frozen shoulder?
Prolonged immobility of shoulder
Most common shoulder dislocation?
Anterior and inferior--affects axillary n
Most common brachial plexus injury?
What is paralyzed in Erb-Duchenne's?
Abduction, external rotation, flexion, supination
Saturday night palsy?
Compression of radial n against humerus as arm is draped over back of chair
Most common cause of injury to radial n?
Most commonly affected nerve injured in UE due to direct trauma?
Upper trunk (C5-6)
Pathogenesis of winging of scapula?
Weakness of anterior serratus due to long thoracic n injury
When is pain elicited in frozen shoulder?
End of ROM
Motions most often affected in adhesive capsulitis?
Abduction, internal and external rotation (extension is preserved)
Most commonly affected rotator cuff muscle?
Pathogenesis of bicipital tenosynovitis?
Inflammation of tendon and its sheath of long head of biceps
Site of pain in supraspinatus tendinitis?
Tip of acromion
Sites of compression of nv bundle in thoracic outlet syndrome?
1) Bt anterior and middle scalenes2) Bt clavicle and 1st rib3) Bt pectoralis minor and upper ribs
Most common somatic dysfunction of AC joint?
Clavicle superior and lateral on acromion
Motion of clavicle during internal/external rotation?
Around transverse axis
Second most common somatic dysfunction of shoulder?
Restriction in abduction
For every 3 degrees of abduction...
Glenohumeral joint moves 2 degrees and the scapulothoracic joint moves 1 degree
Nerve roots of brachial plexus?
What becomes the superficial palmar arterial arch?
Ulnar a (Ulnar is Up in the palm)
Where does brachial a divide into ulnar and radial aa?
Under bicipital aponeurosis
When does the axillary a become the brachial a?
Inferior border of teres minor
Subclavian vein passes where?
Anterior to anterior scalene
Primary internal rotator?
Pec major, lat dorsi
Deltoid (middle portion)
Rotator cuff muscles?
Supraspinatus, Infraspinatus, teres minor, Subscapularis (SItS)
Bones making up the shoulder?
Clavicle, scapula, humerus
Only muscle of thenar eminence NOT innervated by median n?
Adductor pollicis brevis (ulnar n)
Innervation of lumbricals?
1st-2nd innervated by median n; 3rd-4th innervated by ulnar n
What attaches to the DIPs?
Flexor digitorum profundus
What attaches to PIPs?
Flexor digitorum superficialis
Intersection of 1) longitudinal axis of humerus and 2) line from distal radial-ulnar joint passing thru proximal radial-ulnar joint
CA for men?
CA for women?
CA >15 degrees?
Cubitus valgus OR abducation of ulna in SD
Cubitus varus OR adduction of ulna in SD
An increase in CA causes what wrist motion?
Adduction of wrist
A decreased in CA causes what wrist motion?
Abduction of wrist
What motions occur with adduction of ulna?
Lateral glide of olecranon, radius is pulled proximally resulting in abduction of wrist
What motions occur with abduction of ulna?
Medial glide of olecranon, radius is pushed distally resulting in adduction of wrist
Radial head motion?
Anterior with supination; posterior with pronation
Location of reference when naming ulna motion?
Common cause of posterior radial head?
Falling on pronated forearm
Common cause of anterior radial head?
Falling backward on supinated forearm
Gold standard dx for carpul tunnel?
Swan neck deformity?
Flexion contracture of MCP and DIP, extension contracture of PIP
Extension contracture of MCP and DIP, flexion contracture of PIP
Cause of swan neck?
Contracture of intrinsic mm of hand
Cause of boutonniere?
Rupture of hood o extensor tendon at PIP
Primary hip extensor?
Primary hip flexor?
Primary knee extensor?
Primary knee flexors?
Semimembranosus and semitendinosus
4 ligaments that make up femoroacetabular joint?
1) Iliofemoral2) Ischiofemoral3) Pubofemoral4) Capitis femoris
What ligament attaches the head of the femur to the acetabular fossa?
What are the minor motions of the hip?
Anterior and posterior glide
What motion occurs with anterior glide of the head of the femur?
What motion occurs with posterior glide of the head of the femur?
Etiologies of hip external rotation SD?
Piriformis or iliopsoas spasm
Etiologies of hip internal rotation SD?
Spasm of internal rotators
3 joints that make up the knee?
1) Tibiofemoral 2) Patellofemoral3) Tibiofibular
What is the largest joint in the body?
What is the origin and insertion of the ACL?
Originates at posterior aspect of femur, attaches to anterior aspect of tibia
Origin and insertion of the PCL?
Originates at anterior aspect of femur and inserts on posterior aspect of tibia
Which ligament articulates with the medial meniscus and helps prevent valgus stress at the knee?
Medial collateral ligament
Attachments of the lateral collateral ligament?
Femur and fibula
Mvt of the tibiofibular joint occurs with what motions of the foot?
Pronation and supination
What motion occurs when the fibular head glides anteriorly?
What motion occurs when the fibular head glides posteriorly?
Dorsiflexion, eversion, abduction
Plantarflexion, inversion, adduction
Pronation of foot causes what fibular motion?
Causes talus to push distal fibula posteriorly allowing anterior glide proximally
Supination of the foot causes what fibular motion?
Causes anterior talofibular ligament to pull distal fibula anteriorly, and allows proximal fibula to glide posteriorly
Femoral nerve roots?
Sciatic nerve roots?
Femoral n innervations?
Quads, iliacus, sartorius and pectineus
Which foramen does the sciatic n pass thru?
Greater sciatic foramen
85% of population, the sciatic n will be in what relation to piriformis?
Inferior to piriformis
Innervation of short head of biceps femoris?
Peroneal division of sciatic n
Angulation of head of the femur?
Normally 120-135 degrees
Angulation of femur
Angulation of femur >135
Formed by intersection of a line from ASIS thru middle of patella, and a line from tibial tubercle thru middle of patella
Normal Q angle?
Increased Q angle (knocked-kneed)
Decreased Q angle (bow-legged)
What ligament prevents hyperextension of knee?
Posterior fibular head foot positions?
Talus internally rotated causing foot to invert and plantarflex
Anterior fibular head foot positions?
Talus externally rotated causing foot to evert and dorsiflex
What nerve lies directly posterior to the proximal fibular head?
Common peroneal nerve (injured in posterior fibular head SD)
Pathophysiology of patello-femoral syndrome?
Imbalance of musculature of quads (strong vastus lateralis and weak vastus medialis) causing patella to deviate laterally due to larger Q angle
S/S of patello-femoral syndrome?
Deep knee pain esp when climbing stairs, atrophy of vastus medialis, patellar crepitus
Lower leg compartments?
Anterior, lateral, deep posterior, superficial posterior
Which compartment is most commonly affected in compartment syndrome?
S/S of compartment syndrome (anterior)?
Tibialis anterior m is head and tender to palpation, pulse are present, stretching muscle causes extreme pain
O'Donahue's triad (terrible triad)?
ACL, MCL, medial meniscus
Portion of talus that artciulates with ankle mortise?
Trochlea of talus
Which ankle motion is more stable, plantarflexion or dorsiflexion?
Dorsiflexion--bc talus is wider anteriorly
Talocrural joint (tibiotalar joint)?
Hinge joint bt talus and medial malleolus, and lateral melleolus
Main motions of talocrural joint?
Plantarflexion and dorsiflexion
What motion occurs with anterior glide of talus?
What motion occurs with posterior glide of talus?
80% of ankle sprains occur in plantarflexion or dorsiflexion?
Plantarflexion (due to stability of ankle in dorsiflexion)
What joint allows internal/external rotation of leg while foot is fixed?
Subtalar joint (talocalcaneal joint)
Arches of foot?
Longitudinal and transverse
Medial longitudinal arch?
Talus, navicular, cuneiforms, 1-3 metatarsals
Lateral longitudinal arch?
Calcaneus, cuboid, 4-5 metatarsals
Navicular, cuneiforms, cuboid
Where do most SDs occur in foot?
Transverse arch--often seen in long distance runners
Lateral stabilizers of ankle?
ATF, calcaneofibular, posterior talofibular
Most common injured ankle ligament?
Type I ankle sprain?
Type II ankle sprain?
ATF and calcaneofibular
Type III ankle sprain?
ALL 3 lateral ligaments
Excessive pronation usually results in what injury?
Fracture of medial malleolus (rather than pure ligamentous injury)
Calcaneonavicular ligament--strengthens medial longitudinal arch
Attachments of plantar aponeurosis?
Calcaneus and phalanges
What is the primary respiratory mechanism (PRM)?
CNS + CSF + dural membranes + cranial bones + sacrum
What do the brain and spinal cord do during exhalation phase of PRM?
Lengthen and thins
What do the brain and spinal cord do during inhalation phase of PRM?
Shortens and thickens
What is normal cranial rhythmic impulse (CRI)?
What decreases CRI?
Stress, depression, chronic fatigue and chronic infections
What increases CRI?
Vigorous exercise, systemic fever, following OMT to the craniosacral mechanism
What forms the falx cerebri and tentorium cerebelli?
Where does the dura attach?
Foramen magnum, C2, C3, S2
The dura is elastic or inelastic?
Inelastic--when the dura moves, the cranial bones move
What is the reciprocal tension membrane (RTM)?
Mvt of meninges cause cranial motion--called an automatic, shifting, suspension fulcrum
Where does the dura attach to the sacrum?
POSTERIOR superior aspect of S2 (this is where the superior transverse axis runs that allows sacral motion)
What is the sphenobasilar synchondrosis (SBS)?
Articulation of sphenoid with occiput
Motions of SBS?
Flexion and extension
IRE of ERF?
Internal rotation of paired bones occur with extension of midline bones; external rotation occurs with flexion
What are the midline bones?
Sphenoid, occiput, ethmoid, vomer
What causes counternutation?
Flexion (widen head and decrease AP diameter)
Extension (narrow head and increase AP diameter)
What causes nutation?
What are the 5 elements of the PRM?
1) Inherent motility of brain and spinal cord2) Fluctuation of CSF3) Mvt of intracranial and intraspinal membranes4) Articular mobility of cranial bones5) Involuntary mobility of sacrum bt ilia
Axis/plane of motion in torsion?
AP axis, coronal plane
Sphenoid rotates one direction about AP axis, occiput rotation in opposite direction
How are torsion SDs named?
Named for greater wing of sphenoid that is more superior
Axes of motion in SB/rotation?
Rotation about an AP axis thru SBS; sidebending about 2 parallel vertical axes--one passing thru foramen magnum and other thru center of sphenoid
Sphenoid and occiput rotate in SAME direction (unlike torsion) and sidebending about the vertical axes causing deviation of SBS to either right or left
Sidebending to left will cause what rotation?
Sphenoid and occiput will rotate so that they are inferior on the left
Sidebending causes the SBS to deviate which way?
Right SB causes deviation of SBS to right and vice versa
Extension causes what motion of SBS?
SBS will move caudad
Flexion causes what motion of SBS?
SBS will move cephalad
What is vertical strain?
When sphenoid deviates cephalad or caudad in relation to the occiput
Axes of motion in vertical strain?
One tranverse axis thru center of sphenoid, other transverse axis just superior to occiput
What is lateral strain?
Sphenoid deviates laterally in relation to occiput
Axes of motion in lateral strain?
One vertical axis thru center of sphenoid, one vertical axis thru foramen magnum
When sphenoid and occiput are pushed together causing decreased amplitude of flexion and extension
Cause of compression?
Trauma to back of head--if severe enough can obliterate CRI
Site of vagal SD?
OA, AA, C2 dysfunction
Cause of poor suckling in newborn?
Condylar compression (CN XII) and dysfunctions of CN IX and X at jugular foramen
What drains 85-90% of blood from cranium?
What drains 5% of blood from cranium?
Facial veins and external jugular
Venous sinus technique?
Directly spreads apart sutures of cranium that overly occipital, transverse and sagittal sinuses
Purpose of CV4 bulb decompression?
Increase amplitude of CRI
1st resist flexion phase and encourage extension phase until a "still point" is reached, then allow restoration of flexion/extension to occur
What is CV4 good for?
Fluid homeostasis and induce uterine contraction in post-date gravid women
Purpose of vault hold?
Address strains of SBS
Vault hold finger placement?
1) Index on greater wing2) Middle on temporal bone in front of ear3) Ring on mastoid region of temporal bone4) Pinkie on squamous portion of occiput
Purpose of V spread?
To separate restricted or impacted sutures and can be applied to any suture
Purpose of lift technique?
Frontal and parietal lifts are used to aid in balance of membranous tension
Acute intracranial bleeds or increased ICP, skull fracture
Pts with known hx of seizures or dystonia, traumatic brain injury
CN III --> ciliary ganglion --> pupils
Tears and nasal secretions?
CN VII --> sphenopalatine ganglion --> lacrimal and nasal glands
Salivation via submandibular and sublingual glands?
CN VII --> submandibular ganglion --> submandibular and sublingual glands
Salivation via parotids?
CN IX --> otic ganglion --> parotids
Vagus to GU system?
Kidney and UPPER ureter
Vagus to repro system?
Ovaries and testes
Vagus to GI system?
Everything above 1/2 transverse colon
Pelvic splanchnic to GU system?
LOWER ureter and bladder
Pelvic splanchnic to repro system?
Uterus, prostate and genitalia
Pelvic splanchnic to GI system?
Descending colon, sigmoid and rectum
Head and neck?
Anything before ligament of Treitz?
Anything after ligament of Treitz and before the splenic flexure?
Anything after splenic flexure?
Greater splanchnic nerve and celiac ganglion?
Lesser splanchnic nerve and superior mesenteric ganglion?
Least splanchnic nerve and inferior mesenteric ganglion?
Uterus and cervix?
Erectile tissue of penis and clitorus?
Ganglion to kidneys?
Ganglion to upper ureters?
Ganglion to lower ureters?
Entire GI tract?
How would you describe anterior chapman's points?
Smooth, firm, discretely palpable nodules approx 2-3mm in diameter
Where are anterior chapman's points located?
Within deep fascia or on periosteum of bone
Where are posterior chapmna's points located?
Bt spinous and transverse processes
How would you describe posterior chapman's points?
Rubbery, similar to tissues texture changes assoc with classic viscero-somatic reflexes
What will gentle pressure on a chapman's point elicit?
Sharp, nonradiating, exquisitely distressing pain
What are chapman's points?
Somatic manifestations of a visceral dysfunction
Tip of right 12th rib
Transverse process of T11
The presence of which particular reflex helps to direct the DDx more toward acute appendicitis?
Posterior appendix chapman's point
2" superior and 1" lateral to umbilicus
Bt spinous and transverse processes of T11 and T12
1" superior and 1" lateral to umbilicus
Bt spinous and transverse processes of T12 and L1
Lateral thigh within the IT band from greater trochanter to just above knee
Right proximal femur
Right distal femur
Left proximal femur
Left distal femur
What is a trigger point?
May refer pain when pressed
What is a tender point?
DOES NOT refer pain when pressed
Where will trigger points of the SCM refer pain?
Ipsilateral occipital and temporal regions
What trigger point is assoc with supraventricular tachycardias?
Right pectoralis muscle bt 5th and 6th ribs near the sternum
What do trigger points represent?
Somatic manifestations of a viscero-somatic, somato-visceral or somato-somatic reflex
Methods are used to eliminate trigger points?
Neurological or vascular methods
How do you treat myofascial trigger points?
Spray and stretch using vapocoolant spray, injection with local anesthetic
What are tenderpoints used for?
Diagnostic criteria and as a treatment monitor for counterstrain
What type of technique is MFR?
Direct or indirect, active or passive
Applying traction along the long axis of muscle?
Applying compression along the long axis of muscle?
What is the MFR procedure?
1) Palpate restriction2) Apply compression or traction3) Add twisting or transverse forces4) Use enhancers5) Await release
What are the 2 goals of MFR?
1) Restore functional balance2) Improve lymphatic flow
What is the most important diaphragm?
What are the 4 diaphragms?
1) Tentorium cerebelli2) Thoracic inlet3) Abdominal diaphragm4) Pelvic diaphragm
According to Zink, what are the 4 compensatory curves of the spine?
1) OA junction2) Cervicothoracic junction3) Thoracolumbar junction4) Lumbosacral junction
According to Zink, what is the Common Compensatory Pattern?
In 80% of healthy people, OA is rotated left, cervicothoracic is right, thoracolumbar is left, and lumbosacral is right
When performing indirect MFR, which barrier is engaged?
What are contraindications for MFR?
Malignancy, aneurysm, acute RA, febrile state, healing fracture, osteoporosis, open wounds
3 purposes of rib raising?
1) Decrease SNS activity2) Improve lymphatic return3) Encourage max inhalation and provokes a more effective negative pressure
Indications for rib raising?
Visceral dysfunction, decreased rib excursion, lymphatic congestion, fever, paraspinal m spasm
Contraindications for rib raising?
Spinal/rib fracture, recent spinal surgery
Effect of rib raising on SNS activity?
Initial increase in SNS activity, followed by inhibited SNS activity
What can be used to reduce incidence of ileus in post-op patients?
Rib raising, soft tissue paraspinal inhibition
How can lumbar paraspinal inhibition produce the same effects as rib raising?
Bc upper lumbar (L1-2) SNS ganglia is continuous with that of thoracic paraspinal ganglia
Purpose of celiac, SM, and IM ganglia releases?
Decrease SNS activity
Indications for GI ganglia releases?
GI dysfunction, pelvic dysfunction
Contraindications for GI ganglia releases?
Aortic aneurysm, open surgical wound
Purpose of treating Chapman's points?
Decrease SNS tone to assoc visceral tissues
Superior cervical paraspinal ganglia?
Middle cervical paraspinal ganglia?
Inferior cervical paraspinal ganglia?
Purpose of cranial manipulation?
Improve PNS function in head structures innervated by CN III, VII, IX, X
How to reach sphenopalatine ganglion?
Manual finger pressure intraorally
Purpose of sphenopalatine ganglion technique?
Enhance PNS activity to encourage thin watery secretions
Indications for sphenopalatine ganglion technique?
Thick nasal secretions
Purpose of condylar decompression?
Help free PNS responses to structures innervated by CN IX and X by freeing passage thru jugular foramen (i.e. occipito-mastoid suture)
What can condylar compression cause?
Suckling difficulties in newborns
Vagus nerve treatment?
OA, AA, or C2 joint treatment
Purpose of sacral somatic dysfunction treatment?
1) Decrease hyperPNS tone in left colon and pelvis2) Reduce labor pain caused by cervical dilation
Indications for sacral SD treatment?
Dysmenorrhea, labor pain from cervical dilation, constipation
Contraindications for sacral SD treatment?
Local infections or incisions
Which lobe of the lung does NOT drain into the right (minor) duct?
Left upper lobe
What drains into the right (minor) duct?
Right UE, right hemicranium, heart and lobes of lung (except left upper lobe)
Where does the right (minor) duct drain into?
Right brachiocephalic vein OR junction of right IJV and subclavian vein
Where does the left (major) duct drain into?
Junction of left IJV and subclavian veins
Where does the thoracic duct traverse?
Sibson's fascia of the thoracic inlet up to the level of C7 before turning around and empyting into the left (major) duct
Where does the right (minor) duct traverse?
Only traverses the thoracic inlet once
Infection of the right toe would drain where?
Left (major) lymphatic duct
What drains directly into the thoracic duct and bypasses LNs?
1) Thyroid2) Esophagus3) Coronary and triangular ligaments of liver
What has prelymphatics?
Superficial skin, deep portions of peripheral nerves, endomysium, and bones (Haversion canals)
2/3 of lymphatic fluid is produced where?
Liver and intestines
What is the de facto lymph of the CNS?
What level is the cisterna chyli?
Where does the thoracic duct cross the diaphragm?
Aortic hiatus (T12)
When is the lymphatic system developed in utero?
By the 3rd month
What has more valves, lymphatics or veins?
What has "flap valves"?
Terminal lymphatic capillaries--allows fluid to enter
How does interstitial fluid enter the terminal lymphatic vessels?
What is the lymphatic return to the heart in a day?
Entire volume of serum of body
How much extracellular fluid is carried from interstitium to the blood per day?
10-20% or 3 liters
What do the intestinal lymphatics absorb?
Long chain fatty acids, chylomicrons, and cholesterol
What are the main cells found in lymph?
What is the innervation of lymphatics?
SNS (just like vasculature)
What does SNS stimulation do the lymphatics?
Initially causes increased peristalsis, long term hyperSNS tone decreases overall mvt of lymph
What is the SNS control to the lymphatic duct?
What innervates the cisterna chyli?
What is interstitial fluid pressure and flow rate?
-6.3mmHg, rate of 120cc/hr
What if interstitial pressure increases (closer to 0mmHg)?
Increased absorption into lymphatics
What happens if pressure gets above 0mmHg?
Lymphatics collapse--decrease in lymphatic drainage
What factors increase interstitial pressure above 0mmHg?
1) Systemic HTN2) Cirrhosis (decreased plasma protein synthesis)3) Hypoalbuminemia assoc with starvation4) Toxins such as rattlesnake poisoning
What kind of technique is CS?
What is a tenderpoint?
Small tense edematous area of tenderness about the size of a fingertip located near attachments of tendons, ligaments or belly of muscle that do NOT radiate pain
How do you determine a tenderpoint is clinically significant?
Compare to same spot on other side
Where should you start tx if there are multiple tenderpoints?
Tx the most tender area first
Where do you place the pt?
Into position of comfort/ease by shortening the muscle
After fine tuning the tx position with small arcs of motion, how much pain should be reduced?
What is a maverick point?
Tenderpoints that do not improve with fine tuning
How do you tx maverick points?
Place the pt in a position opposite of what would be used typically
How long must the position be maintained?
90 secs--time takes for proprioceptive firing to decrease
How much tenderness should remain after tx?
Anterior cervical TP location?
Anterior to or on most lateral aspect of lateral masses
Tx position for anterior cervical TP?
SB and rotate head away form side of TP
Anterior cervical maverick point (anterior 7th cervical) location?
2-3cm lateral to medial end of clavical at lateral attachment of SCM
Anterior cervical MP tx position?
Flex, SB toward and rotate away from side of TP
Posterior cervical TP location?
Tip of SP or on lateral side of SP
Posterior cervical TP tx position?
Extend, SB (slightly), and rotate away
Posterior cervical MP/inion (posterior 1st cervical) location?
At inion (posterior occipital protuberance) or just below
Posterio cervical MP inion tx position?
Anterior thoracic TPs location?
T1-6 = located midline of sternum at attachment of corresponding ribsT7-12 = most located in rectus abdominus m about 1 inch lateral to midline on right or left
Anterior thoracic TPs tx position?
Flex thorax and add small amount of SB and rotation away
Posterior thoracic TPs location?
Either side of SP or on TP
Posterior thoracic TPs tx position?
Extend, rotate away and SB slightly away
Anterior rib TPs are assoc with what rib position?
Depressed ribs (exhalation dysfunction)
Posterior rib TPs are assoc with what rib position?
Elevated ribs (inhalation dysfunction)
How long must rib tx positions be held?
120 secs--allows pt extra time to relax
Anterior rib 1 TP location?
Just below medial end of clavicle
Anterior rib 2 TP location?
6-8cm lateral to sternum on rib 2
Anterior ribs 3-6 TP locations?
Along mid-axillary line on corresponding rib
Anterior rib tx position for ribs 1 and 2?
Flex head, SB and rotate towards
Anterior rib tx position for ribs 3-6?
SB and rotate thorax toward, encourage slight flexion
Posterior rib TP location?
Angle of corresponding rib
Posterior rib TP tx position?
Tx with minimal flexion, SB and rotate away
Anterior lumbar TP L1 location?
Just medial to ASIS
Anterior lumbar TP L2-4 location?
On the AIIIS
Anterior lumbar TP L5 location?
1cm lateral to pubic symphisis on superior ramus
Anterior lumbar TP tx position?
Most treated with pt supine, knees and hips flexed and markedly rotated away
Posterior lumbar TP location?
Either side of SP or on TP; L3-4 may be on iliac crest; L5 may be on PSIS
Posterior lumbar TP tx position?
Most treated with pt prone, extended and SB away (rotation may be towards or away)
Posterior lumbar MPs (lower pole 5th lumbar) location?
Inferior to PSIS as much as 1 cm
Posterior lumbar MP tx position?
Pt prone, hip and knee flexed, leg internally rotated and adducted
Iliacus TP location?
~7cm medial to ASIS
Iliacus tx position?
Pt supine with hip flexed and externally rotated
Piriformis TP location?
In the piriformis m 7cm medial to and slightly superior to greater trochanter
Piriformis TP tx position?
Pt prone, hip and knee flexed, thigh abducted and externally rotated
What percentage of TPs are maverick?
What region is assoc with the greatest number of MPs?
What type of technique to FPR?
Indirect myofascial release
What are the basic steps of FPR?
1) Straighten AP curvature2) Apply compression3) Shorten muscle by placing into position of ease
How long must the position be held?
What can FPR be used to treat?
Superficial mm, deep intervertebral mm to influence vertebral motion
Purpose of straightening AP curvature?
Decrease kyphosis (thoracic spine) or lordosis (cervical or lumbar spine)
Where must the head be when treating cervical spine?
Off the table
What kind of technique is ME?
Active direct or active indirect (rarely)
Where does the physician initially place the pt for ME?
Directly into the barrier
What is isometric contraction?
Distance bt origin and insertion of muscle remais the same as the muscle contracts (but internal CT will stretch)
What does this isometric contraction cause the golgi tendon to do?
Change tension and causes reflex relaxation of agonist muscle fibers allowing the doc to further engage the barrier
What is reciprocal inhibition?
When antagonist muscles contract, the agonist muscles will reflexively relax
How can reciprocal inhibition be done?
Directly or indirectly
How would you tx a biceps m spasm using direct reciprocal inhibition?
Extend elbow to restrictive barrier, have pt contract triceps against resistance
How would you tx a biceps in spasm using indirect reciprocal inhibition?
Fully flex elbow (away from restrictive barrier), have pt contract triceps against resistance
What is teh oculocephalogyric reflex?
Uses EOM contraction to reflexively effect the cervical and truncal musculature
What is the crossed extensor reflex?
When reflex occurs, the flexors in withdrawing limb contract and extensors relax, while in the other limb the opposite occurs
How long is ME maintained?
How many times is ME repeated?
What is more important, localization of force or intensity of force?
What barriers must be engaged during ME?
The restrictive barrier in ALL planes of motion
When is ME contraindicated?
Post-surgical pts and intensive care pts
Tx position for pump handle inhalation dysfunction?
Flex pts forward while supine
Tx position for bucket handle inhalation dysfunction?
SB towards while supine
Initial tx position for exhalation dysfunctions?
Pt places forearm on affected side across forehead with palm up
Where does pt monitor exhalation dysfunctions during tx?
Posteriorly at rib angle
Isometric contraction for rib 1?
Pt raises head directly toward ceiling
Isometric contraction for rib2?
Pt turns head 30 degrees away from dysfunctional side and lift head toward ceiling
Isometric contraction for ribs 3-5?
Pt pushes elbow of affected side toward opposite ASIS
Isometric contraction for ribs 6-9?
Pt pushes arm anterior
Isometric contraction for ribs 10-12?
Pt adducts arm
Rib 1 muscles being tx?
Anterior and middle scalenes
Rib 2 muscle being tx?
Ribs 3-5 muscle being tx?
Ribs 6-9 muscle being tx?
Ribs 10-11 muscle being tx?
Rib 12 muscle being tx?
Unilateral sacral flexion?
Place hypothenar eminence on pt's ipsilateral ILA, push anterior on ILA during inhalation; resit any posterior mvt during exhalation
Unilateral sacral extension?
Place hypothenar eminence on ipsilateal sacral sulcus, push anterior and caudad on superior sulcus during exhalation; resist anterior superior mvt during inhalaiton
Forward sacral torsion pt position?
Lateral sims position (face down, axis side down) with flexed legs off table
Forward sacral torsion pt activating force?
Lifting legs toward ceiling against equal counterforce
Backward sacral torsion pt position?
Lateral recumbent with face up, axis side down, legs off table
Backward sacral torsion pt activating force?
Lifting legs toward ceiling against equal counterforce
Anterior innominate position?
Flex hip and knee into barrier
Posterior innominate position?
Drop hip and leg off table inducing extension
Pt position for superior pubic shear?
Drop ipsilateral leg off table and abduct until resistance is felt, stabilize opposite ASIS
Pt activating force for superior pubic shear?
Bring ipsilateral knee to opposite ASIS (flexion and adduction)
Pt position for inferior pubic shear?
Flex and abduct pt's ipsilateral hip and knee until resistance is felt, stabilize pt's opposite ASIS
Pt activating force for inferior pubic shear?
Push ipsilateral knee to opposite foot (extension and adduction)
Pt position for anterior fibular head?
Pt prone, knee flexed, hand on lateral side of foot cupping ankle, plantarflex and invert foot, externally rotate tibia
Pt activating force for anterior fibular head?
Pt position for posterior fibular head?
Pt prone, knee flexed, hand on lateral side of foot cupping ankle, plantarflex and invert foot, internally rotate tibia
Pt activating force for posterior fibular head?
What type of technique is HVLA?
Theories of the neurophysiology of HVLA?
1) Forcefully stretching a contracted muscle sends a barrage of afferents to CNS, causes reflex inhibitory signals to the spindles2) Forcefully stretching contracted muscle activates the golgi tendon and reflexively relaxes muscle
When is the final force applied?
What is the main indication of HVLA?
Motion loss in somatic dysfunction
What are the absolute contraindications?
1) Osteoporosis2) Osteomyelitis (including Pott's)3) Fractures in area of thrust4) Bone mets5) Severe RA6) Down's
Why are RA pts at risk?
RA weakens the transverse ligament of the dens, so cervical manipulation may cause AA subluxation
Why are Down's pts at risk?
Laxity in transverse ligament of dens may results in AA subluxation with cervical manipulation
What are the relative contraindications?
1) Acute whiplash2) Pregnancy3) Post-op conditions4) Herniated nucleus pulposus5) Pt's on anticoagulaion or hemophiliacs6) Vertebral artery ischemia (positive Wallenberg's test)
What is the most common MINOR complication?
Soreness or symptom exacerbation
What is the most common MAJOR complication overall?
Vertebral artery injury--usually due to cervical rotatory forces with neck in extended position
What is the most common MAJOR complication in the low back?
Cauda equina syndrome (very rare)
Where is the thrust directed for OA HVLA?
Opposite eye (of rotation)
Direction of thrust for cervical rotational technique?
Direction of thrust for cervical sidebending technique?
Direction of force for flexed thoracics?
At dysfunctional segment and aimed toward floor
Direction of force for extension thoracics?
At vertebrae below dysfunctional segment and thrust is aimed 45 degrees cephalad
Direction of force for neutral thoracics?
Aimed toward floor, sidebend away
Technique for a purely flexed/extended thoracic lesion?
Use bilateral fulcum (thenar eminence under one TP and flexed MCP under the other TP)
Which rib cannot be treated using Kirksville Krunch?
Location of thenar eminence when treating ribs using KK?
Posterior rib angle of key rib
Pt position for rib 1 inhalation dysfunction HVLA?
Supine, SB toward rotate away
Doc's hand placement for rib 1 inhalation dysfunction HVLA?
1st MCP on tubercle of rib 1
Direction of thrust for rib 1 inhalation dysfunction?
Posterioanterior and caudad
Which vertebrae can be treated with HVLA using the lumbar roll?
Arm position when treating type II dysfunction with TP up?
Pull inferior arm down
Arm position when treating type II dysfunction with TP down?
Pull inferior arm up
Arm position when treating type I dysfunction with TP up?
Pull inferior arm up
Arm position when treating type I dysfunction with TP down?
Pull inferior arm down
Patient position for lumbar roll?
Purpose of pulling inferior arm down when treating with lumbar roll?
Who find articulatory techniques more acceptable than other vigorous direct techniques?
Post-op pts and elderly
1) Limited/lost articular motion2) Need to increase frequency or amplitude of motion of body region3) Normalized SNS activity
1) Repeated hyper-rotation of upper cervicals when in extension may damage vertebral artery2) Acutely inflamed joint, such as infection or fracture
What is the typical articulatory procedure?
1) Move joint to the restrictive barrier2) Use respiratory cooperation or ME activation to further increase myofascial stretch3) Return to neutral4) Repeat
What are 2 common articulatory techniques?
1) Rib raising2) Spencer's
What is rib raising useful for?
Those pts who have a resistant or noncompliant chest wall (e.g. viral pneumonia)
What is Spencer's useful for?
What position is the pt in Spencer's?
Lateral recumbent with dysfunction shoulder up
Spencer's stage 1?
Stretch tissues and pumping fluids with arm extended
Spencer's stage 2?
Shoulder extensioni/flexion with elbow flexed
Spencer's stage 3?
Shoulderf flexion/extension with elbow extended
Spencer's stage 4?
1) Circumduction and slight compression with elbow flexed/extended2) Circumduction and traction with elbow extended
Spencer's stage 5?
Adduction and external rotation with elbow flexed
Spencer's stage 6?
Abduction with internal rotation with arm behind back
Spencer's stage 7?
Stretching tissues and pumping fluids with arm extended
Spurling's test (compression test) procedure?
Pt seated, doc extends and SB C-spine toward side being tested
Pain radiating into ipsilateral arm due to nerve root compression
Test for vertebral artery insufficiency
Positive Wallenberg's test?
Pt complains of dizziness, visual changes, lightheadedness, or nystagmus
Pt supine, doc flexes neck, holding for 10 sec, then extends holding for 10 secs, rotation right and left, rotation during flexion, and rotation during extension
Thoracic outlet tests?
1) Adson's2) Wright's3) Costoclavicular syndrome test (military posture test)
What is being tested in Adson's?
Adson's test procedure?
Monitor pt's pule, extend shoulder, externally rotated and slightly abducted; pt then takes deep rbeath and turn head TOWARD ipsilateral arm
What is being tested in Wright's?
Pectoralis minor muscle at coracoid process
Hyperabduct arm above head with some extension while monitoring pulse
What is being tested in military posture test?
Clavicle and 1st rib
Military posture procedure?
Monitor radial pulse while depressing and extending shoulder
Positive test for Adson's, Wright's, and military posture tests?
Severely decreased or absent radial pulse
Drop arm test procedure?
Abduct shoulder to 90, then slowly lower arm
Positive drop arm test procedure?
Unable to lower arm smoothly, or if arm drops indicating rotator cuff tear
Assess biceps tendon in bicipital groove
Speeds test procedure?
Fully extend elbow, flex shoulder and supinate while doc resists shoulder flexion
Positive speeds test?
Tenderness in bicipital groove
Tests stability of biceps tendon in bicipital groove
Yergason's test procedure?
Doc supinates as the pt resists
Biceps tendon pops out of bicipital groove
Assesses adequacy of blood supply to hand by radial and ulnar arteries
Test for tenosynovitis in abductor pollicis longus and extensor pollicis brevis tendons at the wrist (De Quervain's dz)
Reverse Phalen's test (prayer test)?
For dx carpal tunnel--extend wrist while gripping doc's hand
Hip drop test?
Evaluate sidebending (lateral flexion) of lumbar spine
Normal hip drop?
Lumbar spine SBs to side opposite bent knee, ipsilateral iliac crest drops more than 20-25 degrees
Positive hip drop test?
Anything less than a smooth convexity of lumbar spine, or drop of iliac crest
Straight leg test (Lasegue's test)?
Evaluation of sciatic nerve compression
To differentiate bt tight hamstring and sciatic nerve compression, doc dorsiflexes foot
Pain is elicited by dorsiflexion indicating sciatic nerve compression
Seated flexion test?
Assess SI motion (sacrum)
Standing flexion test?
Assess iliosacral motion (innominates)
ASIS compression test?
Determine side of SI dysfunction (esp when standing/seated flexion tests are equivocal)
Pelvic side shift test?
Determines if sacrum is in the midline
Pelvic side shift test procedure?
With pt standing, doc stabilizes the shoulders with one hand and pushes the pelvis to the opposite side, the hands are then switched to check the other pelvis
Positive pelvic side shift test?
Positive on side of freer translation (this indicates that the pelvis is shifted to that side)
What does a positive pelvic side shift test usually indicate?
Flexion contracture of psoas (psoas syndrome)--if contracture on right, there will be positive test to the left
Assesses gluteus medius muscle strength
Side that drops indicates the opposite gluteus medius is weak
Lumbosacral spring test?
Assesses whether or not the sacral base is tilted posterior
Backward bending test (the sphinx test)?
Determines if sacral base moved posterior or anterior
Detects tight tensor fascia lata and IT band
FABER--assess SI and hip joint pathology (esp osteoarthritis)
Assess flexion contracture of hip, usually iliopsoas
Bounce home test?
Tests problem with full knee extension, usually due to meniscal tears or joint effusions
Assess meniscus injury
Assess collateral ligament injury
Detects tears in posterior aspect of menisci
McMurray's for medial meniscus?
Flex hip/knee, palpate medial joint line, tibia is then externally rotated and a valgus stress is applied while slowly extending knee
McMurray's for lateral meniscus?
Flex hip/knee, internally rotate tibia and a varus stress is applied while slowly extending knee
How to test for chondromalacia patellae?
Patellar grind test
Anterior drawer test of ankle?
Assess medial and lateral ligaments of ankle, mainly the ATF ligament
Positive seated or standing flexion tests?
Positive on side of superior PSIS
5th and 6th ICS R
5th ICS L
6th ICS R
7th ICS R
7th ICS L
Tip of 12th rib R
1in lateral 2in superior to umbilicus
1in lateral 1in superior to umbilicus
Superior pubic ramus, 2cm lateral to symphysis
Outer femur (along posterior IT band) bilateral
Center of sternum
Just below xiphoid process
Superior mesenteric ganglion?
Bt points for celiac and inferior mesenteric ganglion
Inferior mesenteric ganglion?
Just above umbilicus
6th ICS L
Middle ear (otitis media)?
1st rib and clavicals, lateral to where they cross the 1st ribs
Surgical neck of humerus
1) Middle ear2) Sinuses
Superior edge of inferior pubic ramus
Outer femur along posterior IT band
Superior pubic ramus, 2cm lateral to symphysis
Few inches above greater trochanter
T2-3 lamina of TP
T2-3 lamina of TP
T2-3 lamina of TP
T2 lamina of TP
T3 lamina of TP
T4 lamina of TP
T5-6 lamina of TP R
T6 lamina of TP R
T7 lamina of TP R
T7 lamina of TP L
T11 lamina R
T11-12 could be unilateral
T12-L1 lamina of TP bilateral
L2 upper edge of TP bilateral
L2 TP bilateral
Lateral sacral base bilateral
C1 posterior lateral pillar
T9 lamina of TP right
Lateral sacral base bilateral
Lateral sacral base bilateral
Lateral sacral base bilateral and upper inner edge of thigh
T10-11 lamina of TP bilateral
Right triangle - lateral edge of TP of L2-4, bottom edge is L4 to iliac crest
Pharynx, tongue, larynx, sinuses, arms?
Bottom edge of C1 pillar