Describe the correct positioning and technique for the Parietal Lift?
- Both forearms resting on table; place fingertips on both parietal bones just superior to parietal-squamous sutures
- Cross thumbs above the sagittal suture (thumbs DO NOT touch pt)
- Doc pulls thumbs against other as if to separate them, increasing pressure on the fingertips --> inducing IR of the parietal bones at the parietal-squamous suture
- While maintaining this light pressure, traction superiorly until fullness is felt at fingertips; this fullness = ER of parietal bones
- Gently release and reasses
Describe the correct positioning and technique for the Frontal Lift?
- Forearms rest on table; doc interlaces fingers above frontal bone w/ hypothenar eminences placed on corresponding lateral angles of front bone; heels of hands in front of the coronal suture
- Apply gentle compressive force medially disengaging frontals from parietals --> IR the frontal bones
- Maintain compression and apply gentle anterior force through frontal bone contacts to disengage the sutual restrictions
- Hold traction until you feel softening and/or expansion of frontal bone = frontal bone moving into ER
What are the points of contact for the 5-finger Temporal Hold?
- Doc places middline finger in pt's external auditory canal
- Using pincer grasp of thumb and index finger contact the superior and inferior border of pt's zygomatic arch
- Place pads of 4th and 5th digits on the mastoid process
- Opposite hand cradles occipital squama, medial to the occipitomastoid sutures
What is the objective of the Rocking the Temporals technique?
List 5 disorders it may help with.
- Release or relieve CN IX, X, XI entrapment/dysfunction
- Eustachian tube compression
- Jugular vein compression
- Restricted temporal/occipital articulation
Using the Rocking the Temporals technique what is the setup and technique to encourage internal rotation?
- Use bilateral or unilateral 5-finger temporal hold
- Thumb and index finger move superomedially
- 4th and 5th digits move inferomedially
Using the Rocking the Temporals technique what is the setup and technique to encourage external rotation?
- Use bilateral or unilateral 5-finger temporal hold
- Thumb and index finger move inferolaterally
- 4th and 5th digits move superomedially
What type of simultaneous motion is encoruaged when performing the Rocking the Temporal technique?
Which motion is to be achieved?
- Simulataneous ER/IR motion in a back-and-forth manner
- Until bones achieve an asynchronous motion... then just monitor allowing physiologic motion to return
If physiologic synchronous motion does not return while using a Rocking the Temporal technique, what should be done?
Gently begin to resist the motions to induce a STILL point
Leaving the temporal bones in an asynchronous motion will often result in?
VERTIGO or other temporal bone problems
What is the objective/utility of the Temporal Pull?
- Balances the tentorium cerebelli and/or temporal bones
- Diengages the petrojugular
- May help release the petrosphenoid
- BLT for the occipitomastoid
What is the correct setup/technique for the Temporal Pull?
Must assess what first?
- Assess motion of the temporal bones first
- Use pincer grip on pinnae as close to temporal bones as possible; while rest of hands wrap around posterior ear
- Apply traction laterally, posteriorly, and superiorly along a vector that parallels the petrous ridge of the temporals
- Encourage inhalation phase (done inherently by lateral pull) and take up slack maintaining tension at the feather's edge of the RB until release is felt
- Reassess motion of temporal bones
What is the correct setup and technique for the Compressionof the Fourth Ventricle (aka CV4) technique?
- Pt supine w/ doc seated at table head; one hand in the palm of other so thenar eminences are parallel (volleyball bump)
- Thenar eminenes are inferior to superior nuchal line and contacting the lateral angle of the occiput medial to occipitomastoid sutures
- Gently encourage extension by leaning back and resist inferior (flexion) motion
- Wait for motion to slow to a "Still Point" (i.e., softening/warming)
- Carefull remove hands and let pts head rest on table; Reassess
Which sutures is the V-spread technique commonly used at?
Asterior, pterion, and OM sutures
*Can be used to release any peripheral sutures!
What is the correct setup and technique for the V-spread?
- Pt is supine, doc seated at table head.
- Ipsilateral hand w/ 2nd and 3rd digits on either side of suture to be released, contralateral hand 180° opposite (palm or 2 fingers contact head)
- Spread the finger pads on both sides of restricted suture to disengage the articulation
- Gently apply a force w/ opposing hand towards dysf. suture
- Adjust until response (fluid flow or tide) felt at V-spread fingers and then reassess motion of paired bones and at suture
Which cranial bone is the only bone that contacts all 4 fontanelles?
What are the relevant grooves/sulci on the inner surface of the parietal bone?
- Sagittal sulcus: a groove in which sagittal sinus runs
- Groove of the middle meningeal a. (anterior and posterior)
- Lateral part of the groove for the Transverse Sinus: carries marginal insertion of the tentorium cerebelli
During SBS flexion how does the sagittal and temporal articulation of the parietal bone move?
- Sagittal articulation moves inferiorly
- Temporal articulation moves laterally
*Cranium widens laterally = ER of the parietals
During SBS extension how does the sagittal and temporal articulation of the parietal bone move?
- Sagittal articulation moves superiorly
- Temporal articulation moves medially
*Cranium narrows laterally = IR of the parietals
The OM and asterion are often involved in what type of HA's?
The Pterion is often involved in what type of HA's?
Head, face, and tooth pain are often related to what trigger point?
Temporal SD (TrP)
What is the most common form of Synostosis?
Which type of synostosis is most commonly mistaken for posterior positional deformational plagiocephaly and must be closely evaluated?
What is the effect of IR and ER of the temporals on the Eustachian Tube?
- IR of temporals places pressure on eustachian tube --> HIGH pitched tinnitus
- ER of temporals produces low roaring sound or LOW pitched tinnitus
During SBS flexion/extension the motion of the temporal bone is driven by?
The OCCIPUT through the OM articulation
Bell's Palsy (CN VII) can be associated with SD of which cranial bone?
Which direction does the squamous portion of the Temporal bone move with SBS flexion/extension?
- SBS Flexion the squamous portion moves laterally, as the temporal bones ER
- SBS Extension the squamous portion moves medially, as the temporal bones IR
How does the frontal bone move with SBS flexion (i.e., lateral side and glabella)?
- Into ER
- Lateral side moves anterior/lateral and slightly inferior
- Glabella moves posterior
How does the frontal bone move with SBS extension (i.e., lateral side and glabella)?
- Into IR
- Lateral side moves posterior/medial and slightly superior
- Glabella moves anteriorly
Which type of HA's are the coronal suture and pterion involved in with Frontal Bone SD?
- Coronal often involved in tension HA
- Pterion often involved in temporal HA