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Flashcards in Full deck Deck (795):
1

Cervical superior facet orientation?

Backward, upward, medial

2

Thoracic superior facet orientation?

Backward, upward, lateral

3

Lumbar superior facet orientation?

Backward, medial

4

Isotonic contraction?

Muscle contraction that results in tension remaining the same while muscle length shortens; operator's force is less than patient's force

5

Isometric contraction?

Muscle contraction that results in the increase in tension without a change in muscle length; operator's force is equal to patient's force

6

Isolytic contraction?

Muscle contraction against resistance while forcing the muscle to lengthen; operator's force is more than patient's force

7

Concentric contraction?

Muscle contraction that results in the approximation of the muscle's origin and insertion

8

Eccentric contraction?

Lengthening of muscle during contraction due to an external force

9

Myofascial release?

Direct and indirect, active and passive

10

Counterstrain?

Indirect, passive

11

Facilitated positional release?

Indirect, passive

12

Muscle energy?

Direct, active

13

HVLA?

Direct, passive

14

Cranial?

Direct and indirect, passive

15

Lymphatic treatment?

Direct, passive

16

Chapman's reflexes?

Direct, passive

17

In type I dysfunction, what motion precedes what?

SB precedes rotation (OSR)

18

In type II dysfunction, what motion precedes what?

Rotation precedes SB (TRS)

19

What is the only subjective component of TART?

Tenderness

20

2 types of isotonic contraction?

1) Concentric (shortening)2) Eccentric (lengthening)

21

Upward mvt of a bicep curl?

Concentric contraction

22

Downward mvt of a bicep curl?

Eccentric

23

Contraction in which tension remains the same?

Isotonic

24

Which vertebra has no spinous process or vertebral body?

C1

25

Which vertebrae have bifid spinoud processes?

C2-6

26

What portion of the cervical vertebrae lies bt the superior and inferior facets?

Articular pillars (or lateral masses)

27

What is located posterior to the cervical transverse processes?

Articular pillars

28

What is used by DO's to evaluate cervical vertebral motion?

Articular pillars

29

What vertebrae do the vertebral arteries pass thru?

C1-6

30

What do the vertebral arteries pass thru?

Foramen transversarium

31

Where do the scalenes originate?

Posterior tubercle of the transverse processes of the cervical vertebrae

32

Where does the anterior scalene insert?

Rib 1

33

Where does the middle scalene insert?

Rib 1

34

Where does the posterior scalene insert?

Rib 2

35

What are the actions of the scalenes?

Sidebend to same side with unilateral contraction, flex with bilateral contraction (also aid in respiration)

36

Where would you find a scalene tenderpoint in a rib dysfunction?

Posterior to clavicle at base of neck

37

Where does the SCM originate?

Mastoid and lateral half of superior nuchal line

38

Where does the SCM insert?

Medial 1/3 of clavicle and sternum

39

What are the actions of the SCM?

With unilateral contraction, will sidebend ipsilaterally and rotate contralaterally; bilateral contraction flexes head

40

Shortening or restrictions within the SCM results in what?

Torticollis

41

What ligament extends from the sides of the dens to the lateral margins of the foramen magnum?

Alar ligament

42

What ligament attaches to the lateral masses of C1 to hold the dens in place?

Transverse ligament of the atlas

43

What syndromes can weaken the alar and transverse ligaments resulting in AA subluxation?

Down's and RA

44

What are uncinate processes?

Superior lateral projections originating from the posterior lateral rim of the vertebral bodies of C3-7

45

What is the joint of Luschka (unconvertebral joints)?

The articulation of the superior uncinate process and superadjacent vertebrae

46

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

47

Where does C8 nerve root exit?

Between C7 and T1

48

What nerve roots make up the brachial plexus?

C5-T1

49

What is the primary motion of the OA?

Flexion and extension--50% of flexion/extension of cervical spine occurs at OA

50

How does sidebending occur at OA?

Opposite rotation

51

What is the primary motion of the AA?

Rotation--50% of rotation of cervical spine occurs at AA

52

What are the mvts of C2-7

Sidebending and rotation occur to the same side

53

Main motions of C2-4?

Rotation

54

Main motions of C5-7?

Sidebending

55

Lateral translation to the right will cause what motion?

Left sidebending

56

What if you feel a deep sulcus on the right at the OA joint?

Rotated right, sidebent left

57

How do you evaluate the AA?

Flex cervical spine to 45 degrees to lock out rotation of typical cervical vertebrae

58

An acute injury to the cervical spine is best treated how?

MFR or counterstrain

59

How does cervical foraminal stenosis present?

Neck pain radiating to upper extremity

60

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

61

Which vertebra actually rotates, the atlas or axis?

Atlas rotates on axis

62

Which cervical segment is best assessed by flexing neck to 45 and rotating?

C1

63

T1-3 rule of 3's?

SP is located at level of corresponding TP

64

T4-6 rule of 3's?

SP is located one-half a sefment below the corresponding TP

65

T7-9 rule of 3's?

SP is located at level of TP of vertebrae below

66

Follows same rules as T7-9?

T10

67

Follows same rules as T5-7?

T11

68

Follows same rules as T1-3?

T12

69

Spine of scapula is at what level?

T3

70

Inferior angle of scapula corresponds with what?

Spinous process of T7

71

Sternal notch is at what level?

T2

72

Sternal angle (angle of Louis) attaches to which rib and what level is it?

2nd rib, level of T4

73

What is the main motion of the thoracic spine?

Rotation

74

Upper and middle thoracic spine motion?

Rotation > flexion/extension > SB

75

Lower thoracic spine motion?

Flexion/extension > SB > rotation

76

Primary muscles of respiration?

Diaphragm, intercostals

77

Rib attachments for diaphragm?

Ribs 6-12 b/l

78

Vertebral attachments for diaphragm?

L1-3

79

Anterior attachment for diaphragm?

Xiphoid

80

Action of intercostal muscles?

Elevate ribs during inspiration and prevent retractions during inspiration

81

Secondary muscles of respiration?

Scalenes, pec minor, serratus anterior/posteiror, quadratus lumborum, latissimus dorsi

82

What makes a typical rib typical?

Contains Shaft, Head, Angle, Neck, Tubercle (SHANT)

83

What is the difference bt head and tubercle of rib?

Head--articulates with vertebra above and corresponding vertebra; tubercule--articulates with corresponding TP

84

Typical ribs?

3-10

85

Atypical ribs?

1, 2, 11, 12 (ribs with "1" and "2"), sometimes 10

86

Reason why rib 1 is atypical?

Articulates only with T1 and has no angle

87

Reason why rib 2 is atypical?

Has large tuberosity on shaft for serratus anterior

88

Reason why ribs 11 and 12 are atypical?

They articulate only with corresponding vertebrae and lack tubercles

89

Reason why rib 10 may be atypical?

May articulate only with T10

90

True ribs?

1-7 (attach to sternum thru costal cartilages)

91

False ribs?

8-12 (connected by its costal cartilage to the cartilage of the rib superior)

92

Floating ribs?

11, 12

93

Rib motions?

Pump handle, bucket handle, caliper

94

Move primarily in pump handle?

Ribs 1-5

95

Move primarily in bucket handle?

Ribs 6-10

96

Move primarily in caliper?

Ribs 11 and 12

97

Rib appears to be "held up", will not move caudad?

Inhalation dysfunction

98

Rib appears "held down", will not move cephalad?

Exhalation dysfunction

99

Rib elevated anteriorly?

Pump handle inhalation dysfunction (depressed anteriorly for exhalation dysfunction)

100

Rib elevated laterally?

Bucket handle inhalation dysfunction (depressed laterally for exhalation dysfunction)

101

Anterior narrowing of intercostal space above dysfunctional rib?

Pump handle inhalation dysfunction (opposite for exhalation dysfunction)

102

Lateral narrowing of intercostal space above dysfunctional rib?

Bucket handle inhalation dysfunction (opposite for exhalation dysfunction)

103

Superior edge of posterior rib angle is prominent?

Pump handle inhalation dysfunction (opposite for exhalation dysfunction)

104

Lower edge of rib shaft is prominent?

Bucket handle inhalation dysfunction

105

What is the key rib responsible for group inhalation dysfunctions?

Lowest rib

106

What is the key rib responsible for group exhalation dysfunction?

Uppermost rib

107

Where is tx directed for a group dysfunction?

Key rib

108

Reason why lumbar spine is more susceptible to disc herniation?

Narrowing of posterior longitudinal ligament

109

Comparison of posterior longitudinal ligament at L1 and at L4-5?

Is 1/2 the width at L4-5 than at L1

110

Location of where spinal cord terminates?

L1-2

111

Location of where nerve roots exit in lumbar spine?

Below corresponding vertebrae, but above the IV disc

112

Origin of iliopsoas m?

T12-L5 vertebral bodies

113

Insertion of iliopsoas m?

Lesser trochanter

114

Erector spinae mm from lateral to medial?

Iliocostalis, Longissimus, Spinalis (I Love Spine)

115

Level of iliac crest?

L4-L5

116

T10 dermatome at umbilicus is anterior to which IV disc?

L3-L4

117

Most common anomaly in lumbar spine?

Facet trophism--predisposes to early degenerative changes

118

What is facet trophism?

Lumbar facet joints are aligned in coronal plane (instead of sagittal)

119

What is sacralization?

TPs of L5 are long and articulate with sacrum--predisposes to early degenerative changes

120

What is lumbarization?

Failure of fusion of S1 with other sacral segements

121

What is spina bifida?

Defect in closure of limina of vertebral segment

122

3 types of spina bifida?

Occulta, meningocele, meningomyelocele

123

Alignment of lumbar facets?

Backward and medial for superior facets

124

Major motion of lumbar spine?

Flexion and extension (small degree of SB, limited rotation)

125

Sidebending of L5 will cause what sacral motion?

Sacral oblique axis will be engaged on same side

126

Rotation of L5 will cause what sacral motion?

Sacrum will rotate toward opposite side

127

Ferguson's angle?

Lumbosacral angle--formed by intersection of a horizontal line and the line of inclination of the sacrum (25-35 degrees)

128

98% of disc herniations occur where?

Between L4-5 or L5-S1

129

A herniation bt L4-5 will exert pressure on which nerve root?

L5 (the nerve root below)

130

Positive test seen in disc herniation?

Straight leg raising test

131

What is relatively CI in herniation?

HVLA

132

OMT for herniation?

Initially indirect techniques, then gentle direct

133

Positive test seen in psoas syndrome?

Thomas test

134

Tender point seen in psoas syndrome?

Medial to ASIS

135

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

136

When do you stretch psoas m in psoas syndrome?

Chronic spasms

137

OMT for psoas syndrome?

Counterstrain to anterior iliopsoas tenderpoint followed by ME/HVLA to high lumbar dysfunction

138

Causes of spinal stenosis?

Hypertrophy of facet joints, Ca deposits within ligamentum flavum and posterior longitudinal l, loss of IV disc height

139

Radiology for spinal stenosis?

Osteophytes and decreased IV disc space, foraminal narrowing on oblique views

140

What is spondylolisthesis?

Anterior displacement of one vertebrae in relation to one below due to fractures in the pars interarticularis

141

Where does spondylolisthesis occur?

L4 or L5

142

What are the neuro deficits in spondylolisthesis?

None

143

What is a positive vertebral step-off sign?

Palpating the spinous process there is an obvious forward displacement at the area of listhesis

144

S/S of spondylolisthesis?

Pain with extension-based activities, tight hams b/l, stiff-legged, short stride, waddling gait

145

Goal of tx for spondylolisthesis?

Reduce lumbar lordosis and somatic dysfunction

146

What is CI in spondylolisthesis?

HVLA

147

Grading for spondylolisthesis?

1 = 0-25%; 2 = 25-50%; 3 = 50-75%; 4 = >75%

148

What is spondylolysis?

Defect of pars interarticularis WITHOUT anterior displacement of vertebral body

149

Radiology for spondylolysis?

Scotty dog on oblique view--fracture of pars interarticularis

150

What is spondylosis?

Radiological term for degenerative changes within IV disc and ankylosing of adjacent vertebral bodies

151

How do you dx spondylolisthesis vs. spondylolysis?

Spondylolisthesis = lateral x-ray; sponylolysis = oblique x-ray

152

Cause of cauda equina syndrome?

Massive central disc herniation

153

S/S of cauda equina syndrome?

Saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel/bladder control

154

Result of delay in surgery for tx cauda equina?

Irreversible paralysis

155

Epidemiology of scoliosis?

5% of school-aged children develop it before 15

156

Percentage of children with actual sxs related to their scoliosis?

10%

157

Female: Male ratio for scoliosis?

4:01

158

Dextroscoliosis?

Curve that is SB left = scoliosis to the right

159

Levoscoliosis?

Curve that is SB right = scoliosis to the left

160

2 types of scoliosis curves?

1) Structural curve2) Functional curve

161

Which curve is fixed and inflexible?

Structural

162

Which curve will NOT correct with sidebending in opposite direction?

Structural

163

Which is assoc with vertebral wedging and shortened ligaments/musccles on concave side?

Structural

164

T/F An uncorrected functional curve may progress to a structural curve?

TRUE

165

When should kids be screened?

10-15 years

166

What is the angle measures the degree of scoliosis?

Cobb angle

167

What is Cobb angle?

Draw horizontal line from vertebral bodies of extreme ends of curve; then draw perpendicular lines from these horizontal lines

168

At what angle is respiratory function compromised?

>50

169

At what angle is cardiac function compromised?

>75

170

What are the causes of scoliosis?

Idiopathic, congenital, neuromuscular, acquired

171

Which type is most often progressive?

Congenital

172

What are Konstancin exercises?

A series of specific exercises that has been proven to improve the pt with scoliotic postural decompensation

173

When is bracing indicated?

Moderate scoliosis

174

When i surgery indicated?

Severe scoliosis--if there is resp compromise or if it progresses despite conservative management

175

3 things that cause short leg?

1) Sacral base unleveling2) Vertebral SB and rotation3) Innominate rotation

176

Most common cause of anatomical short leg?

Hip replacement

177

First ligament to be stressed in short leg?

Iliolumbar ligaments, then the SI ligaments

178

Sacral base unleveling compensation?

Sacral base will be lower on short leg side

179

Innominate compensation?

Anterior rotation on short leg side; posterior rotation on long leg side

180

Lumbar spine compensation?

SB away, rotate toward short leg side

181

Lumbosacral (Ferguson's) angle compensation?

Increased 2-3 degrees

182

How to quantify differences in heights of femoral head for short leg syndrome?

Standing x-ray

183

When to consider heel lift?

Femoral head difference >5mm

184

When should the full lift be administered?

Sudden onset of discrepancy (e.g. fracture, surgery)

185

What should the final lift height be?

1/2 - 3/4 of measured leg length discrpancy

186

What should the "fragile" pt begin with?

1/16" (1.5mm) and increase 1/16" every 2 weeks

187

What should the "flexible" pt begin with?

1/8" (3.2mm) and increase 1/8" every 2 weeks

188

What is the max height that can be applied to INSIDE the shoe?

1/4"

189

What if >1/4" is needed?

Apply to OUTSIDE of shoe

190

What is maximum heel lift possible?

1/2"

191

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

192

Most common cause of scoliosis?

Idiopathic

193

When do the 3 bones of the innominate fuse?

20 years old

194

Anterior portion of 1st segment (S1)?

Sacral promontory

195

Sacral base?

Top (most cephalad) part

196

In somatic dysfunctions, what can be recorded as shallow (posterior) or deep (anterior)?

Sacral base or sacral sulci

197

How can you record the sacral ILA's?

Shallow (posterior), deep (anterior), superior or inferior

198

The SI joint is an inverted "L" joint with 2 arms converging anteriorly. Where do these arms join?

S2

199

2 types of pelvic ligaments/

True and accessory

200

True pelvic ligaments?

Anterior, posterior and interosseous SI ligaments

201

Accessory pelvic ligaments?

Sacrotuberous, sacrospinous, iliolumbar ligaments

202

What ligament divides the greater and lesser sciatic foramen?

Sacrospinous ligament

203

Which ligament is the 1st to become painful in lumbosacral decompensation?

Iliolumbar ligament

204

Types of pelvic muscles?

Primary and secondary

205

Primary pelvic muscles?

Make up pelvic diaphragm--levator ani, coccygeus

206

Secondary pelvic muscles?

Iliopsoas, obturator internus, piriformis

207

Origin/insertion of piriformis?

ILA, greater trochanter

208

Action of piriformis?

Ext rot, extend thigh, abducts thigh with hip flexed

209

Innervation of piriformis?

S1 and S2 nerve roots

210

What are S/S of sciatica due to hypertonic piriformis?

Pain from buttock radiating down thigh but not past knee

211

Axis upon innominates rotate?

Inferior transverse axis (S4)

212

4 types of sacral motion?

1) Dynamic motion2) Respiratory motion3) Inherent (craniosacral) motion4) Postural motion

213

Location of transverse axis for resp and inherent motion of sacrum?

S2 (superior transverse axis)

214

Craniosacral flexion induces what sacral motion?

Counternutates (rotates posterior)

215

Craniosacral extension induces what sacral motion?

Nutation (rotates anterior)

216

Axis during dynamic sacral motion (walking)?

Oblique axes

217

Axis during postural motion?

Middle transverse axis (S3)

218

When L5 is SB, what sacral axis is engaged and where?

Oblique axis on the same side as side bending

219

When L5 is rotated, the sacrum rotates which way?

Opposite on an oblique axis

220

Where is the seated flexion test positive in sacral SD?

Opposite the oblique axis

221

B/l sacral flexion or extension move around what sacral axis?

Middle transverse

222

What is a common sacral dysfunction in the postpartum patient?

B/l sacral flexion

223

What axis does the sacrum rotate in a sacral margin posterior SD?

Mid-vertical or parasagittal

224

What is treated first, L5 or sacrum?

L5

225

Joints of the shoulder/

Scapulothoracic (pseudo-joint), AC joint, glenohumeral, SC joint

226

Primary flexor?

Deltoid (anterior portion)

227

Primary extensors?

Lat dorsi, teres major, deltoid (posterior portion)

228

Primary external rotators?

Infraspinatus, teres minor

229

Subclavian artery passes bt which 2 muscles?

Anterior and middle scalenes--contracture of these muscles affects arterial supply but not venous drainage

230

When does subclavian a become axillary a?

Lateral border of 1st rib

231

1st major branch of brachial a?

Profunda brachial a--accompanies radial n in its posterior course of radial groove

232

What becomes the deep palmar arterial arch?

Radial a

233

Tx technique to relieve lymph congestion of UE?

1) Open thoracic inlet2) Redome diaphragm3) Posterior axillary fold technique

234

Degrees of motion during arm abduction?

120 degrees due to glenohumeral motion, 60 degree due to scapulothoracic motion

235

Most common somatic dysfunction of shoulder?

Restriction in internal and external rotation

236

Least common somatic dysfunction of shoulder?

Restriction in extension

237

Most common somatic dysfunction of SC joint?

Clavicle anterior and superior on sternum

238

"Step-off" seen at the AC joint?

Superior and lateral clavicle on acromion

239

Pathogenesis of supraspinatus tendinitis?

Continuous impingement of greater tuberosity against acromion as arm is flexed and internally rotated

240

"Painful arc"?

Pain exacerbated by abduction from 60-120 degrees in supraspinatus tendinitis

241

Aggravating factors in bicipital tenosynovitis?

Elbow flexion or supination

242

Location of pain in rotator cuff tear?

Tenderness just below tip of acromion

243

Etiology of frozen shoulder?

Prolonged immobility of shoulder

244

Most common shoulder dislocation?

Anterior and inferior--affects axillary n

245

Most common brachial plexus injury?

Erb-Duchenne's palsy

246

What is paralyzed in Erb-Duchenne's?

Abduction, external rotation, flexion, supination

247

Crutch palsy?

Radial n

248

Saturday night palsy?

Compression of radial n against humerus as arm is draped over back of chair

249

Most common cause of injury to radial n?

Humeral fracture

250

Most commonly affected nerve injured in UE due to direct trauma?

Radial n

251

Erb-Duchenne's?

Upper trunk (C5-6)

252

Pathogenesis of winging of scapula?

Weakness of anterior serratus due to long thoracic n injury

253

When is pain elicited in frozen shoulder?

End of ROM

254

Motions most often affected in adhesive capsulitis?

Abduction, internal and external rotation (extension is preserved)

255

Most commonly affected rotator cuff muscle?

Supraspinatus

256

Pathogenesis of bicipital tenosynovitis?

Inflammation of tendon and its sheath of long head of biceps

257

Site of pain in supraspinatus tendinitis?

Tip of acromion

258

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

259

Most common somatic dysfunction of AC joint?

Clavicle superior and lateral on acromion

260

Motion of clavicle during internal/external rotation?

Around transverse axis

261

Second most common somatic dysfunction of shoulder?

Restriction in abduction

262

For every 3 degrees of abduction...

Glenohumeral joint moves 2 degrees and the scapulothoracic joint moves 1 degree

263

Nerve roots of brachial plexus?

C5-T1

264

What becomes the superficial palmar arterial arch?

Ulnar a (Ulnar is Up in the palm)

265

Where does brachial a divide into ulnar and radial aa?

Under bicipital aponeurosis

266

When does the axillary a become the brachial a?

Inferior border of teres minor

267

Subclavian vein passes where?

Anterior to anterior scalene

268

Primary internal rotator?

Subscapularis

269

Primary adductors?

Pec major, lat dorsi

270

Primary abductor?

Deltoid (middle portion)

271

Rotator cuff muscles?

Supraspinatus, Infraspinatus, teres minor, Subscapularis (SItS)

272

Bones making up the shoulder?

Clavicle, scapula, humerus

273

Only muscle of thenar eminence NOT innervated by median n?

Adductor pollicis brevis (ulnar n)

274

Innervation of lumbricals?

1st-2nd innervated by median n; 3rd-4th innervated by ulnar n

275

What attaches to the DIPs?

Flexor digitorum profundus

276

What attaches to PIPs?

Flexor digitorum superficialis

277

Carrying angle?

Intersection of 1) longitudinal axis of humerus and 2) line from distal radial-ulnar joint passing thru proximal radial-ulnar joint

278

CA for men?

5 degrees

279

CA for women?

10-12 degrees

280

CA >15 degrees?

Cubitus valgus OR abducation of ulna in SD

281

CA

Cubitus varus OR adduction of ulna in SD

282

An increase in CA causes what wrist motion?

Adduction of wrist

283

A decreased in CA causes what wrist motion?

Abduction of wrist

284

What motions occur with adduction of ulna?

Lateral glide of olecranon, radius is pulled proximally resulting in abduction of wrist

285

What motions occur with abduction of ulna?

Medial glide of olecranon, radius is pushed distally resulting in adduction of wrist

286

Radial head motion?

Anterior with supination; posterior with pronation

287

Location of reference when naming ulna motion?

Distal ulna

288

Common cause of posterior radial head?

Falling on pronated forearm

289

Common cause of anterior radial head?

Falling backward on supinated forearm

290

Gold standard dx for carpul tunnel?

EMG

291

Swan neck deformity?

Flexion contracture of MCP and DIP, extension contracture of PIP

292

Boutonniere deformity?

Extension contracture of MCP and DIP, flexion contracture of PIP

293

Cause of swan neck?

Contracture of intrinsic mm of hand

294

Cause of boutonniere?

Rupture of hood o extensor tendon at PIP

295

Primary hip extensor?

Gluteus maximus

296

Primary hip flexor?

Iliopsoas

297

Primary knee extensor?

Quadriceps

298

Primary knee flexors?

Semimembranosus and semitendinosus

299

4 ligaments that make up femoroacetabular joint?

1) Iliofemoral2) Ischiofemoral3) Pubofemoral4) Capitis femoris

300

What ligament attaches the head of the femur to the acetabular fossa?

Capitis femoris

301

What are the minor motions of the hip?

Anterior and posterior glide

302

What motion occurs with anterior glide of the head of the femur?

External rotation

303

What motion occurs with posterior glide of the head of the femur?

Internal rotation

304

Etiologies of hip external rotation SD?

Piriformis or iliopsoas spasm

305

Etiologies of hip internal rotation SD?

Spasm of internal rotators

306

3 joints that make up the knee?

1) Tibiofemoral 2) Patellofemoral3) Tibiofibular

307

What is the largest joint in the body?

Tibiofemoral

308

What is the origin and insertion of the ACL?

Originates at posterior aspect of femur, attaches to anterior aspect of tibia

309

Origin and insertion of the PCL?

Originates at anterior aspect of femur and inserts on posterior aspect of tibia

310

Which ligament articulates with the medial meniscus and helps prevent valgus stress at the knee?

Medial collateral ligament

311

Attachments of the lateral collateral ligament?

Femur and fibula

312

Mvt of the tibiofibular joint occurs with what motions of the foot?

Pronation and supination

313

What motion occurs when the fibular head glides anteriorly?

Pronation

314

What motion occurs when the fibular head glides posteriorly?

Supination

315

Pronation motions?

Dorsiflexion, eversion, abduction

316

Supination motions?

Plantarflexion, inversion, adduction

317

Pronation of foot causes what fibular motion?

Causes talus to push distal fibula posteriorly allowing anterior glide proximally

318

Supination of the foot causes what fibular motion?

Causes anterior talofibular ligament to pull distal fibula anteriorly, and allows proximal fibula to glide posteriorly

319

Femoral nerve roots?

L2-4

320

Sciatic nerve roots?

L4-S3

321

Femoral n innervations?

Quads, iliacus, sartorius and pectineus

322

Which foramen does the sciatic n pass thru?

Greater sciatic foramen

323

85% of population, the sciatic n will be in what relation to piriformis?

Inferior to piriformis

324

Innervation of short head of biceps femoris?

Peroneal division of sciatic n

325

Angulation of head of the femur?

Normally 120-135 degrees

326

Coxa vara?

Angulation of femur

327

Coxa valga?

Angulation of femur >135

328

Q angle?

Formed by intersection of a line from ASIS thru middle of patella, and a line from tibial tubercle thru middle of patella

329

Normal Q angle?

10-12 degrees

330

Genu valgum?

Increased Q angle (knocked-kneed)

331

Genu varum?

Decreased Q angle (bow-legged)

332

What ligament prevents hyperextension of knee?

ACL

333

Posterior fibular head foot positions?

Talus internally rotated causing foot to invert and plantarflex

334

Anterior fibular head foot positions?

Talus externally rotated causing foot to evert and dorsiflex

335

What nerve lies directly posterior to the proximal fibular head?

Common peroneal nerve (injured in posterior fibular head SD)

336

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

337

S/S of patello-femoral syndrome?

Deep knee pain esp when climbing stairs, atrophy of vastus medialis, patellar crepitus

338

Lower leg compartments?

Anterior, lateral, deep posterior, superficial posterior

339

Which compartment is most commonly affected in compartment syndrome?

Anterior

340

S/S of compartment syndrome (anterior)?

Tibialis anterior m is head and tender to palpation, pulse are present, stretching muscle causes extreme pain

341

O'Donahue's triad (terrible triad)?

ACL, MCL, medial meniscus

342

Portion of talus that artciulates with ankle mortise?

Trochlea of talus

343

Which ankle motion is more stable, plantarflexion or dorsiflexion?

Dorsiflexion--bc talus is wider anteriorly

344

Talocrural joint (tibiotalar joint)?

Hinge joint bt talus and medial malleolus, and lateral melleolus

345

Main motions of talocrural joint?

Plantarflexion and dorsiflexion

346

What motion occurs with anterior glide of talus?

Plantarflexion

347

What motion occurs with posterior glide of talus?

Dorsiflexion

348

80% of ankle sprains occur in plantarflexion or dorsiflexion?

Plantarflexion (due to stability of ankle in dorsiflexion)

349

What joint allows internal/external rotation of leg while foot is fixed?

Subtalar joint (talocalcaneal joint)

350

Arches of foot?

Longitudinal and transverse

351

Medial longitudinal arch?

Talus, navicular, cuneiforms, 1-3 metatarsals

352

Lateral longitudinal arch?

Calcaneus, cuboid, 4-5 metatarsals

353

Tranverse arch?

Navicular, cuneiforms, cuboid

354

Where do most SDs occur in foot?

Transverse arch--often seen in long distance runners

355

Lateral stabilizers of ankle?

ATF, calcaneofibular, posterior talofibular

356

Most common injured ankle ligament?

ATF

357

Type I ankle sprain?

Only ATF

358

Type II ankle sprain?

ATF and calcaneofibular

359

Type III ankle sprain?

ALL 3 lateral ligaments

360

Excessive pronation usually results in what injury?

Fracture of medial malleolus (rather than pure ligamentous injury)

361

Spring ligament?

Calcaneonavicular ligament--strengthens medial longitudinal arch

362

Attachments of plantar aponeurosis?

Calcaneus and phalanges

363

What is the primary respiratory mechanism (PRM)?

CNS + CSF + dural membranes + cranial bones + sacrum

364

What do the brain and spinal cord do during exhalation phase of PRM?

Lengthen and thins

365

What do the brain and spinal cord do during inhalation phase of PRM?

Shortens and thickens

366

What is normal cranial rhythmic impulse (CRI)?

14-Oct

367

What decreases CRI?

Stress, depression, chronic fatigue and chronic infections

368

What increases CRI?

Vigorous exercise, systemic fever, following OMT to the craniosacral mechanism

369

What forms the falx cerebri and tentorium cerebelli?

Dura mater

370

Where does the dura attach?

Foramen magnum, C2, C3, S2

371

The dura is elastic or inelastic?

Inelastic--when the dura moves, the cranial bones move

372

What is the reciprocal tension membrane (RTM)?

Mvt of meninges cause cranial motion--called an automatic, shifting, suspension fulcrum

373

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)

374

What is the sphenobasilar synchondrosis (SBS)?

Articulation of sphenoid with occiput

375

Motions of SBS?

Flexion and extension

376

IRE of ERF?

Internal rotation of paired bones occur with extension of midline bones; external rotation occurs with flexion

377

What are the midline bones?

Sphenoid, occiput, ethmoid, vomer

378

What causes counternutation?

SBS flexion

379

Bert head?

Flexion (widen head and decrease AP diameter)

380

Ernie head?

Extension (narrow head and increase AP diameter)

381

What causes nutation?

SBS extension

382

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

383

Axis/plane of motion in torsion?

AP axis, coronal plane

384

Torsion motions?

Sphenoid rotates one direction about AP axis, occiput rotation in opposite direction

385

How are torsion SDs named?

Named for greater wing of sphenoid that is more superior

386

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

387

SB/rotation motions?

Sphenoid and occiput rotate in SAME direction (unlike torsion) and sidebending about the vertical axes causing deviation of SBS to either right or left

388

Sidebending to left will cause what rotation?

Sphenoid and occiput will rotate so that they are inferior on the left

389

Sidebending causes the SBS to deviate which way?

Right SB causes deviation of SBS to right and vice versa

390

Extension causes what motion of SBS?

SBS will move caudad

391

Flexion causes what motion of SBS?

SBS will move cephalad

392

What is vertical strain?

When sphenoid deviates cephalad or caudad in relation to the occiput

393

Axes of motion in vertical strain?

One tranverse axis thru center of sphenoid, other transverse axis just superior to occiput

394

What is lateral strain?

Sphenoid deviates laterally in relation to occiput

395

Axes of motion in lateral strain?

One vertical axis thru center of sphenoid, one vertical axis thru foramen magnum

396

Compression?

When sphenoid and occiput are pushed together causing decreased amplitude of flexion and extension

397

Cause of compression?

Trauma to back of head--if severe enough can obliterate CRI

398

Site of vagal SD?

OA, AA, C2 dysfunction

399

Cause of poor suckling in newborn?

Condylar compression (CN XII) and dysfunctions of CN IX and X at jugular foramen

400

What drains 85-90% of blood from cranium?

Venous sinuses

401

What drains 5% of blood from cranium?

Facial veins and external jugular

402

Venous sinus technique?

Directly spreads apart sutures of cranium that overly occipital, transverse and sagittal sinuses

403

Purpose of CV4 bulb decompression?

Increase amplitude of CRI

404

CV4 technique?

1st resist flexion phase and encourage extension phase until a "still point" is reached, then allow restoration of flexion/extension to occur

405

What is CV4 good for?

Fluid homeostasis and induce uterine contraction in post-date gravid women

406

Purpose of vault hold?

Address strains of SBS

407

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

408

Purpose of V spread?

To separate restricted or impacted sutures and can be applied to any suture

409

Purpose of lift technique?

Frontal and parietal lifts are used to aid in balance of membranous tension

410

Absolute contraindications?

Acute intracranial bleeds or increased ICP, skull fracture

411

Relative contraindications?

Pts with known hx of seizures or dystonia, traumatic brain injury

412

Miosis?

CN III --> ciliary ganglion --> pupils

413

Tears and nasal secretions?

CN VII --> sphenopalatine ganglion --> lacrimal and nasal glands

414

Salivation via submandibular and sublingual glands?

CN VII --> submandibular ganglion --> submandibular and sublingual glands

415

Salivation via parotids?

CN IX --> otic ganglion --> parotids

416

Vagus to GU system?

Kidney and UPPER ureter

417

Vagus to repro system?

Ovaries and testes

418

Vagus to GI system?

Everything above 1/2 transverse colon

419

Pelvic splanchnic to GU system?

LOWER ureter and bladder

420

Pelvic splanchnic to repro system?

Uterus, prostate and genitalia

421

Pelvic splanchnic to GI system?

Descending colon, sigmoid and rectum

422

Head and neck?

T1-4

423

Heart?

T1-5

424

Respiratory system?

T2-7

425

Esophagus?

T2-8

426

Anything before ligament of Treitz?

T5-9

427

Spleen?

T5-9

428

Anything after ligament of Treitz and before the splenic flexure?

T10-11

429

Anything after splenic flexure?

T12-L2

430

Greater splanchnic nerve and celiac ganglion?

T5-9

431

Lesser splanchnic nerve and superior mesenteric ganglion?

T10-11

432

Least splanchnic nerve and inferior mesenteric ganglion?

T12-L2

433

Appendix?

T12

434

Kidneys?

T10-11

435

Adrenal medulla?

T10

436

Upper ureters?

T10-11

437

Lower ureters?

T12-L1

438

Bladder?

T11-L2

439

Gonads?

T10-11

440

Uterus and cervix?

T10-L2

441

Erectile tissue of penis and clitorus?

T11-L2

442

Prostate?

T12-L2

443

Arms?

T2-8

444

Legs?

T11-L2

445

Ganglion to kidneys?

Superior mesenteric

446

Ganglion to upper ureters?

Superior mesenteric

447

Ganglion to lower ureters?

Inferior mesenteric

448

Entire GI tract?

T5-L2

449

L3-L5?

NOTHING!

450

How would you describe anterior chapman's points?

Smooth, firm, discretely palpable nodules approx 2-3mm in diameter

451

Where are anterior chapman's points located?

Within deep fascia or on periosteum of bone

452

Where are posterior chapmna's points located?

Bt spinous and transverse processes

453

How would you describe posterior chapman's points?

Rubbery, similar to tissues texture changes assoc with classic viscero-somatic reflexes

454

What will gentle pressure on a chapman's point elicit?

Sharp, nonradiating, exquisitely distressing pain

455

What are chapman's points?

Somatic manifestations of a visceral dysfunction

456

Anterior appendix?

Tip of right 12th rib

457

Posterior appendix?

Transverse process of T11

458

The presence of which particular reflex helps to direct the DDx more toward acute appendicitis?

Posterior appendix chapman's point

459

Anterior adrenal?

2" superior and 1" lateral to umbilicus

460

Posterior andrenals?

Bt spinous and transverse processes of T11 and T12

461

Anterior kidneys?

1" superior and 1" lateral to umbilicus

462

Posterior kidney?

Bt spinous and transverse processes of T12 and L1

463

Bladder?

Periumbilical region

464

Colon?

Lateral thigh within the IT band from greater trochanter to just above knee

465

Cecum?

Right proximal femur

466

Hepatic flexure?

Right distal femur

467

Sigmoid colon?

Left proximal femur

468

Splenic flexure?

Left distal femur

469

What is a trigger point?

May refer pain when pressed

470

What is a tender point?

DOES NOT refer pain when pressed

471

Where will trigger points of the SCM refer pain?

Ipsilateral occipital and temporal regions

472

What trigger point is assoc with supraventricular tachycardias?

Right pectoralis muscle bt 5th and 6th ribs near the sternum

473

What do trigger points represent?

Somatic manifestations of a viscero-somatic, somato-visceral or somato-somatic reflex

474

Methods are used to eliminate trigger points?

Neurological or vascular methods

475

How do you treat myofascial trigger points?

Spray and stretch using vapocoolant spray, injection with local anesthetic

476

What are tenderpoints used for?

Diagnostic criteria and as a treatment monitor for counterstrain

477

What type of technique is MFR?

Direct or indirect, active or passive

478

Applying traction along the long axis of muscle?

Direct technique

479

Applying compression along the long axis of muscle?

Indirect technique

480

What is the MFR procedure?

1) Palpate restriction2) Apply compression or traction3) Add twisting or transverse forces4) Use enhancers5) Await release

481

What are the 2 goals of MFR?

1) Restore functional balance2) Improve lymphatic flow

482

What is the most important diaphragm?

Abdominal

483

What are the 4 diaphragms?

1) Tentorium cerebelli2) Thoracic inlet3) Abdominal diaphragm4) Pelvic diaphragm

484

According to Zink, what are the 4 compensatory curves of the spine?

1) OA junction2) Cervicothoracic junction3) Thoracolumbar junction4) Lumbosacral junction

485

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

486

When performing indirect MFR, which barrier is engaged?

Anatomic

487

What are contraindications for MFR?

Malignancy, aneurysm, acute RA, febrile state, healing fracture, osteoporosis, open wounds

488

3 purposes of rib raising?

1) Decrease SNS activity2) Improve lymphatic return3) Encourage max inhalation and provokes a more effective negative pressure

489

Indications for rib raising?

Visceral dysfunction, decreased rib excursion, lymphatic congestion, fever, paraspinal m spasm

490

Contraindications for rib raising?

Spinal/rib fracture, recent spinal surgery

491

Effect of rib raising on SNS activity?

Initial increase in SNS activity, followed by inhibited SNS activity

492

What can be used to reduce incidence of ileus in post-op patients?

Rib raising, soft tissue paraspinal inhibition

493

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

494

Purpose of celiac, SM, and IM ganglia releases?

Decrease SNS activity

495

Indications for GI ganglia releases?

GI dysfunction, pelvic dysfunction

496

Contraindications for GI ganglia releases?

Aortic aneurysm, open surgical wound

497

Purpose of treating Chapman's points?

Decrease SNS tone to assoc visceral tissues

498

Superior cervical paraspinal ganglia?

C1-3

499

Middle cervical paraspinal ganglia?

C6-7

500

Inferior cervical paraspinal ganglia?

C7-T1

501

Purpose of cranial manipulation?

Improve PNS function in head structures innervated by CN III, VII, IX, X

502

How to reach sphenopalatine ganglion?

Manual finger pressure intraorally

503

Purpose of sphenopalatine ganglion technique?

Enhance PNS activity to encourage thin watery secretions

504

Indications for sphenopalatine ganglion technique?

Thick nasal secretions

505

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)

506

What can condylar compression cause?

Suckling difficulties in newborns

507

Vagus nerve treatment?

OA, AA, or C2 joint treatment

508

Purpose of sacral somatic dysfunction treatment?

1) Decrease hyperPNS tone in left colon and pelvis2) Reduce labor pain caused by cervical dilation

509

Indications for sacral SD treatment?

Dysmenorrhea, labor pain from cervical dilation, constipation

510

Contraindications for sacral SD treatment?

Local infections or incisions

511

Which lobe of the lung does NOT drain into the right (minor) duct?

Left upper lobe

512

What drains into the right (minor) duct?

Right UE, right hemicranium, heart and lobes of lung (except left upper lobe)

513

Where does the right (minor) duct drain into?

Right brachiocephalic vein OR junction of right IJV and subclavian vein

514

Where does the left (major) duct drain into?

Junction of left IJV and subclavian veins

515

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

516

Where does the right (minor) duct traverse?

Only traverses the thoracic inlet once

517

Infection of the right toe would drain where?

Left (major) lymphatic duct

518

What drains directly into the thoracic duct and bypasses LNs?

1) Thyroid2) Esophagus3) Coronary and triangular ligaments of liver

519

What has prelymphatics?

Superficial skin, deep portions of peripheral nerves, endomysium, and bones (Haversion canals)

520

2/3 of lymphatic fluid is produced where?

Liver and intestines

521

What is the de facto lymph of the CNS?

CSF

522

What level is the cisterna chyli?

L2

523

Where does the thoracic duct cross the diaphragm?

Aortic hiatus (T12)

524

When is the lymphatic system developed in utero?

By the 3rd month

525

What has more valves, lymphatics or veins?

Lymphatics--semilunar

526

What has "flap valves"?

Terminal lymphatic capillaries--allows fluid to enter

527

How does interstitial fluid enter the terminal lymphatic vessels?

Micropinocytosis

528

What is the lymphatic return to the heart in a day?

Entire volume of serum of body

529

How much extracellular fluid is carried from interstitium to the blood per day?

10-20% or 3 liters

530

What do the intestinal lymphatics absorb?

Long chain fatty acids, chylomicrons, and cholesterol

531

What are the main cells found in lymph?

Lymphocytes

532

What is the innervation of lymphatics?

SNS (just like vasculature)

533

What does SNS stimulation do the lymphatics?

Initially causes increased peristalsis, long term hyperSNS tone decreases overall mvt of lymph

534

What is the SNS control to the lymphatic duct?

Intercostal nerves

535

What innervates the cisterna chyli?

T11

536

What is interstitial fluid pressure and flow rate?

-6.3mmHg, rate of 120cc/hr

537

What if interstitial pressure increases (closer to 0mmHg)?

Increased absorption into lymphatics

538

What happens if pressure gets above 0mmHg?

Lymphatics collapse--decrease in lymphatic drainage

539

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

540

What kind of technique is CS?

Passive indirect

541

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

542

How do you determine a tenderpoint is clinically significant?

Compare to same spot on other side

543

Where should you start tx if there are multiple tenderpoints?

Tx the most tender area first

544

Where do you place the pt?

Into position of comfort/ease by shortening the muscle

545

After fine tuning the tx position with small arcs of motion, how much pain should be reduced?

>70%

546

What is a maverick point?

Tenderpoints that do not improve with fine tuning

547

How do you tx maverick points?

Place the pt in a position opposite of what would be used typically

548

How long must the position be maintained?

90 secs--time takes for proprioceptive firing to decrease

549

How much tenderness should remain after tx?

75-100% better

550

Anterior cervical TP location?

Anterior to or on most lateral aspect of lateral masses

551

Tx position for anterior cervical TP?

SB and rotate head away form side of TP

552

Anterior cervical maverick point (anterior 7th cervical) location?

2-3cm lateral to medial end of clavical at lateral attachment of SCM

553

Anterior cervical MP tx position?

Flex, SB toward and rotate away from side of TP

554

Posterior cervical TP location?

Tip of SP or on lateral side of SP

555

Posterior cervical TP tx position?

Extend, SB (slightly), and rotate away

556

Posterior cervical MP/inion (posterior 1st cervical) location?

At inion (posterior occipital protuberance) or just below

557

Posterio cervical MP inion tx position?

Marked flexion

558

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

559

Anterior thoracic TPs tx position?

Flex thorax and add small amount of SB and rotation away

560

Posterior thoracic TPs location?

Either side of SP or on TP

561

Posterior thoracic TPs tx position?

Extend, rotate away and SB slightly away

562

Anterior rib TPs are assoc with what rib position?

Depressed ribs (exhalation dysfunction)

563

Posterior rib TPs are assoc with what rib position?

Elevated ribs (inhalation dysfunction)

564

How long must rib tx positions be held?

120 secs--allows pt extra time to relax

565

Anterior rib 1 TP location?

Just below medial end of clavicle

566

Anterior rib 2 TP location?

6-8cm lateral to sternum on rib 2

567

Anterior ribs 3-6 TP locations?

Along mid-axillary line on corresponding rib

568

Anterior rib tx position for ribs 1 and 2?

Flex head, SB and rotate towards

569

Anterior rib tx position for ribs 3-6?

SB and rotate thorax toward, encourage slight flexion

570

Posterior rib TP location?

Angle of corresponding rib

571

Posterior rib TP tx position?

Tx with minimal flexion, SB and rotate away

572

Anterior lumbar TP L1 location?

Just medial to ASIS

573

Anterior lumbar TP L2-4 location?

On the AIIIS

574

Anterior lumbar TP L5 location?

1cm lateral to pubic symphisis on superior ramus

575

Anterior lumbar TP tx position?

Most treated with pt supine, knees and hips flexed and markedly rotated away

576

Posterior lumbar TP location?

Either side of SP or on TP; L3-4 may be on iliac crest; L5 may be on PSIS

577

Posterior lumbar TP tx position?

Most treated with pt prone, extended and SB away (rotation may be towards or away)

578

Posterior lumbar MPs (lower pole 5th lumbar) location?

Inferior to PSIS as much as 1 cm

579

Posterior lumbar MP tx position?

Pt prone, hip and knee flexed, leg internally rotated and adducted

580

Iliacus TP location?

~7cm medial to ASIS

581

Iliacus tx position?

Pt supine with hip flexed and externally rotated

582

Piriformis TP location?

In the piriformis m 7cm medial to and slightly superior to greater trochanter

583

Piriformis TP tx position?

Pt prone, hip and knee flexed, thigh abducted and externally rotated

584

What percentage of TPs are maverick?

5%

585

What region is assoc with the greatest number of MPs?

Cervical spine

586

What type of technique to FPR?

Indirect myofascial release

587

What are the basic steps of FPR?

1) Straighten AP curvature2) Apply compression3) Shorten muscle by placing into position of ease

588

How long must the position be held?

3-4 secs

589

What can FPR be used to treat?

Superficial mm, deep intervertebral mm to influence vertebral motion

590

Purpose of straightening AP curvature?

Decrease kyphosis (thoracic spine) or lordosis (cervical or lumbar spine)

591

Where must the head be when treating cervical spine?

Off the table

592

What kind of technique is ME?

Active direct or active indirect (rarely)

593

Where does the physician initially place the pt for ME?

Directly into the barrier

594

What is isometric contraction?

Distance bt origin and insertion of muscle remais the same as the muscle contracts (but internal CT will stretch)

595

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

596

What is reciprocal inhibition?

When antagonist muscles contract, the agonist muscles will reflexively relax

597

How can reciprocal inhibition be done?

Directly or indirectly

598

How would you tx a biceps m spasm using direct reciprocal inhibition?

Extend elbow to restrictive barrier, have pt contract triceps against resistance

599

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

600

What is teh oculocephalogyric reflex?

Uses EOM contraction to reflexively effect the cervical and truncal musculature

601

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

602

How long is ME maintained?

3-5 secs

603

How many times is ME repeated?

3-5 times

604

What is more important, localization of force or intensity of force?

Localization

605

What barriers must be engaged during ME?

The restrictive barrier in ALL planes of motion

606

When is ME contraindicated?

Post-surgical pts and intensive care pts

607

Tx position for pump handle inhalation dysfunction?

Flex pts forward while supine

608

Tx position for bucket handle inhalation dysfunction?

SB towards while supine

609

Initial tx position for exhalation dysfunctions?

Pt places forearm on affected side across forehead with palm up

610

Where does pt monitor exhalation dysfunctions during tx?

Posteriorly at rib angle

611

Isometric contraction for rib 1?

Pt raises head directly toward ceiling

612

Isometric contraction for rib2?

Pt turns head 30 degrees away from dysfunctional side and lift head toward ceiling

613

Isometric contraction for ribs 3-5?

Pt pushes elbow of affected side toward opposite ASIS

614

Isometric contraction for ribs 6-9?

Pt pushes arm anterior

615

Isometric contraction for ribs 10-12?

Pt adducts arm

616

Rib 1 muscles being tx?

Anterior and middle scalenes

617

Rib 2 muscle being tx?

Posterior scalene

618

Ribs 3-5 muscle being tx?

Pectoralis minor

619

Ribs 6-9 muscle being tx?

Serratus anterior

620

Ribs 10-11 muscle being tx?

Lat dorsi

621

Rib 12 muscle being tx?

Quadratus lumborum

622

Unilateral sacral flexion?

Place hypothenar eminence on pt's ipsilateral ILA, push anterior on ILA during inhalation; resit any posterior mvt during exhalation

623

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

624

Forward sacral torsion pt position?

Lateral sims position (face down, axis side down) with flexed legs off table

625

Forward sacral torsion pt activating force?

Lifting legs toward ceiling against equal counterforce

626

Backward sacral torsion pt position?

Lateral recumbent with face up, axis side down, legs off table

627

Backward sacral torsion pt activating force?

Lifting legs toward ceiling against equal counterforce

628

Anterior innominate position?

Flex hip and knee into barrier

629

Posterior innominate position?

Drop hip and leg off table inducing extension

630

Pt position for superior pubic shear?

Drop ipsilateral leg off table and abduct until resistance is felt, stabilize opposite ASIS

631

Pt activating force for superior pubic shear?

Bring ipsilateral knee to opposite ASIS (flexion and adduction)

632

Pt position for inferior pubic shear?

Flex and abduct pt's ipsilateral hip and knee until resistance is felt, stabilize pt's opposite ASIS

633

Pt activating force for inferior pubic shear?

Push ipsilateral knee to opposite foot (extension and adduction)

634

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

635

Pt activating force for anterior fibular head?

Dorsiflex

636

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

637

Pt activating force for posterior fibular head?

Dorsiflex

638

What type of technique is HVLA?

Passive direct

639

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

640

When is the final force applied?

Relaxation/exhalation phase

641

What is the main indication of HVLA?

Motion loss in somatic dysfunction

642

What are the absolute contraindications?

1) Osteoporosis2) Osteomyelitis (including Pott's)3) Fractures in area of thrust4) Bone mets5) Severe RA6) Down's

643

Why are RA pts at risk?

RA weakens the transverse ligament of the dens, so cervical manipulation may cause AA subluxation

644

Why are Down's pts at risk?

Laxity in transverse ligament of dens may results in AA subluxation with cervical manipulation

645

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)

646

What is the most common MINOR complication?

Soreness or symptom exacerbation

647

What is the most common MAJOR complication overall?

Vertebral artery injury--usually due to cervical rotatory forces with neck in extended position

648

What is the most common MAJOR complication in the low back?

Cauda equina syndrome (very rare)

649

Where is the thrust directed for OA HVLA?

Opposite eye (of rotation)

650

Direction of thrust for cervical rotational technique?

Opposite eye

651

Direction of thrust for cervical sidebending technique?

Opposite shoulder

652

Direction of force for flexed thoracics?

At dysfunctional segment and aimed toward floor

653

Direction of force for extension thoracics?

At vertebrae below dysfunctional segment and thrust is aimed 45 degrees cephalad

654

Direction of force for neutral thoracics?

Aimed toward floor, sidebend away

655

Technique for a purely flexed/extended thoracic lesion?

Use bilateral fulcum (thenar eminence under one TP and flexed MCP under the other TP)

656

Which rib cannot be treated using Kirksville Krunch?

Rib 1

657

Location of thenar eminence when treating ribs using KK?

Posterior rib angle of key rib

658

Pt position for rib 1 inhalation dysfunction HVLA?

Supine, SB toward rotate away

659

Doc's hand placement for rib 1 inhalation dysfunction HVLA?

1st MCP on tubercle of rib 1

660

Direction of thrust for rib 1 inhalation dysfunction?

Posterioanterior and caudad

661

Which vertebrae can be treated with HVLA using the lumbar roll?

T10-L5

662

Arm position when treating type II dysfunction with TP up?

Pull inferior arm down

663

Arm position when treating type II dysfunction with TP down?

Pull inferior arm up

664

Arm position when treating type I dysfunction with TP up?

Pull inferior arm up

665

Arm position when treating type I dysfunction with TP down?

Pull inferior arm down

666

Patient position for lumbar roll?

Lateral recumbent

667

Purpose of pulling inferior arm down when treating with lumbar roll?

Induce sidebending

668

Who find articulatory techniques more acceptable than other vigorous direct techniques?

Post-op pts and elderly

669

Indications?

1) Limited/lost articular motion2) Need to increase frequency or amplitude of motion of body region3) Normalized SNS activity

670

Contraindications?

1) Repeated hyper-rotation of upper cervicals when in extension may damage vertebral artery2) Acutely inflamed joint, such as infection or fracture

671

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

672

What are 2 common articulatory techniques?

1) Rib raising2) Spencer's

673

What is rib raising useful for?

Those pts who have a resistant or noncompliant chest wall (e.g. viral pneumonia)

674

What is Spencer's useful for?

Adhesive capsulitis

675

What position is the pt in Spencer's?

Lateral recumbent with dysfunction shoulder up

676

Spencer's stage 1?

Stretch tissues and pumping fluids with arm extended

677

Spencer's stage 2?

Shoulder extensioni/flexion with elbow flexed

678

Spencer's stage 3?

Shoulderf flexion/extension with elbow extended

679

Spencer's stage 4?

1) Circumduction and slight compression with elbow flexed/extended2) Circumduction and traction with elbow extended

680

Spencer's stage 5?

Adduction and external rotation with elbow flexed

681

Spencer's stage 6?

Abduction with internal rotation with arm behind back

682

Spencer's stage 7?

Stretching tissues and pumping fluids with arm extended

683

Spurling's test (compression test) procedure?

Pt seated, doc extends and SB C-spine toward side being tested

684

Positive Spurling's?

Pain radiating into ipsilateral arm due to nerve root compression

685

Wallenberg's test?

Test for vertebral artery insufficiency

686

Positive Wallenberg's test?

Pt complains of dizziness, visual changes, lightheadedness, or nystagmus

687

Wallenberg's procedure?

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

688

Thoracic outlet tests?

1) Adson's2) Wright's3) Costoclavicular syndrome test (military posture test)

689

What is being tested in Adson's?

Tight scalenes

690

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

691

What is being tested in Wright's?

Pectoralis minor muscle at coracoid process

692

Wright's procedure?

Hyperabduct arm above head with some extension while monitoring pulse

693

What is being tested in military posture test?

Clavicle and 1st rib

694

Military posture procedure?

Monitor radial pulse while depressing and extending shoulder

695

Positive test for Adson's, Wright's, and military posture tests?

Severely decreased or absent radial pulse

696

Drop arm test procedure?

Abduct shoulder to 90, then slowly lower arm

697

Positive drop arm test procedure?

Unable to lower arm smoothly, or if arm drops indicating rotator cuff tear

698

Speeds test?

Assess biceps tendon in bicipital groove

699

Speeds test procedure?

Fully extend elbow, flex shoulder and supinate while doc resists shoulder flexion

700

Positive speeds test?

Tenderness in bicipital groove

701

Yergason's test?

Tests stability of biceps tendon in bicipital groove

702

Yergason's test procedure?

Doc supinates as the pt resists

703

Positive Yergason's?

Biceps tendon pops out of bicipital groove

704

Allen's test?

Assesses adequacy of blood supply to hand by radial and ulnar arteries

705

Finkelstein test?

Test for tenosynovitis in abductor pollicis longus and extensor pollicis brevis tendons at the wrist (De Quervain's dz)

706

Reverse Phalen's test (prayer test)?

For dx carpal tunnel--extend wrist while gripping doc's hand

707

Hip drop test?

Evaluate sidebending (lateral flexion) of lumbar spine

708

Normal hip drop?

Lumbar spine SBs to side opposite bent knee, ipsilateral iliac crest drops more than 20-25 degrees

709

Positive hip drop test?

Anything less than a smooth convexity of lumbar spine, or drop of iliac crest

710

Straight leg test (Lasegue's test)?

Evaluation of sciatic nerve compression

711

Braggard's test?

To differentiate bt tight hamstring and sciatic nerve compression, doc dorsiflexes foot

712

Positive Braggard's?

Pain is elicited by dorsiflexion indicating sciatic nerve compression

713

Seated flexion test?

Assess SI motion (sacrum)

714

Standing flexion test?

Assess iliosacral motion (innominates)

715

ASIS compression test?

Determine side of SI dysfunction (esp when standing/seated flexion tests are equivocal)

716

Pelvic side shift test?

Determines if sacrum is in the midline

717

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

718

Positive pelvic side shift test?

Positive on side of freer translation (this indicates that the pelvis is shifted to that side)

719

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

720

Trendelenburg test?

Assesses gluteus medius muscle strength

721

Positive Trendelenburg?

Side that drops indicates the opposite gluteus medius is weak

722

Lumbosacral spring test?

Assesses whether or not the sacral base is tilted posterior

723

Backward bending test (the sphinx test)?

Determines if sacral base moved posterior or anterior

724

Ober's test?

Detects tight tensor fascia lata and IT band

725

Patrick's test?

FABER--assess SI and hip joint pathology (esp osteoarthritis)

726

Thomas test?

Assess flexion contracture of hip, usually iliopsoas

727

Bounce home test?

Tests problem with full knee extension, usually due to meniscal tears or joint effusions

728

Apley's compression?

Assess meniscus injury

729

Apley's distraction?

Assess collateral ligament injury

730

McMurray's test?

Detects tears in posterior aspect of menisci

731

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

732

McMurray's for lateral meniscus?

Flex hip/knee, internally rotate tibia and a varus stress is applied while slowly extending knee

733

How to test for chondromalacia patellae?

Patellar grind test

734

Anterior drawer test of ankle?

Assess medial and lateral ligaments of ankle, mainly the ATF ligament

735

Positive seated or standing flexion tests?

Positive on side of superior PSIS

736

Myocardium?

2nd ICS

737

Esophagus?

2nd ICS

738

Thyroid?

2nd ICS

739

Bronchi?

2nd ICS

740

Upper lung?

3rd ICS

741

Lower lung?

4th ICS

742

Liver?

5th and 6th ICS R

743

Stomach (hyperacidity)?

5th ICS L

744

Gallbladder?

6th ICS R

745

Pancreas?

7th ICS R

746

Spleen?

7th ICS L

747

Appendix?

Tip of 12th rib R

748

Adrenals?

1in lateral 2in superior to umbilicus

749

Kidneys?

1in lateral 1in superior to umbilicus

750

Bladder?

Peri-umbilical area

751

Urethra?

Superior pubic ramus, 2cm lateral to symphysis

752

Prostate?

Outer femur (along posterior IT band) bilateral

753

Pylorus?

Center of sternum

754

Celiac ganglion?

Just below xiphoid process

755

Superior mesenteric ganglion?

Bt points for celiac and inferior mesenteric ganglion

756

Inferior mesenteric ganglion?

Just above umbilicus

757

Stomach (peristalsis)?

6th ICS L

758

Small intestine?

8-10th ICS

759

Tonsils?

1st ICS

760

Middle ear (otitis media)?

1st rib and clavicals, lateral to where they cross the 1st ribs

761

Eyes?

Surgical neck of humerus

762

1st rib?

1) Middle ear2) Sinuses

763

Tongue?

2nd rib

764

Uterus?

Superior edge of inferior pubic ramus

765

Broad ligament?

Outer femur along posterior IT band

766

Ovaries?

Superior pubic ramus, 2cm lateral to symphysis

767

Intestine (peristalsis)?

Few inches above greater trochanter

768

Myocardium?

T2-3 lamina of TP

769

Esophagus?

T2-3 lamina of TP

770

Thyroid?

T2-3 lamina of TP

771

Bronchi?

T2 lamina of TP

772

Upper lung?

T3 lamina of TP

773

Lower lung?

T4 lamina of TP

774

Liver?

T5-6 lamina of TP R

775

Stomach acid?

T5 L

776

Stomach peristalsis?

T6 L

777

Gallbladder?

T6 lamina of TP R

778

Pancreas?

T7 lamina of TP R

779

Spleen?

T7 lamina of TP L

780

Appendix?

T11 lamina R

781

Adrenals?

T11-12 could be unilateral

782

Kidneys?

T12-L1 lamina of TP bilateral

783

Bladder?

L2 upper edge of TP bilateral

784

Urethra?

L2 TP bilateral

785

Prostate?

Lateral sacral base bilateral

786

Ear?

C1 posterior lateral pillar

787

Pylorus?

T9 lamina of TP right

788

Uterus?

Lateral sacral base bilateral

789

Broad ligament?

Lateral sacral base bilateral

790

Vagina?

Lateral sacral base bilateral and upper inner edge of thigh

791

Ovaries?

T10-11 lamina of TP bilateral

792

Large intestine?

Right triangle - lateral edge of TP of L2-4, bottom edge is L4 to iliac crest

793

Pharynx, tongue, larynx, sinuses, arms?

C2

794

Nasal sinuses?

Bottom edge of C1 pillar

795

Peristalsis (intestine)?

Rib 11