OMM Flashcards
1
Q
Scoliosis
- what is it
- levo
- dextro
- tx
A
- lateral deviation of the spine when viewed from behind
- apex of curve to left and concavity to right
- apex of curve to right and concavity to left
- less than 30 degrees, watch, 30-40 degrees brace, greater than 40 operate
2
Q
Barriers
- physiologic
- anatomic
A
- point to which pt can actively move
- point to which pt can passively move
3
Q
Fryettes Principle
- I: segments, rotation and side bending, position of spine
- II: segments, rotation and side bending, position of spine
- exception
A
- mulitple, opposite, neutrial
- single, same side, flexion/extension
- cervical vert
4
Q
Cervical vertebrae movement
- OA
- AA
- 1-7
- C2-4 vs 5-7
A
- uncoupled
- only rotation
- coupled
- 2-4 for rotation and 5-7 sidebending
5
Q
Sympathetics
- Head and neck
- Heart
- Lungs
- GI
A
- T1-T4
- T1- T5
- T2-T7
- T5-L2; prox to lig of treitx T5-9, in between LOT and splenic flex is T9-12, distal to splenic flex T12-L2
6
Q
Sequence of TX
- Thoracic, ribs, cervical
- extremities
A
- treat spine before ribs and cervical dysfxns
- treat axial skeleton first then work prox to distal
7
Q
Location of brachial plexus
A
- between ant and middle scalenes
8
Q
Torticollis
- muscle involved and usual fxn
A
- SCM
- sidebend to same side, rotates to opp side, flexes; bilateral contraction flexes the neck
9
Q
Rule of 3
- T1-3
- T4-6
- T7-9
- T10
- T11
- T12
A
- same level
- TP half segment above SP
- TP whole segment above SP
- TP whole segment above SP
- TP half segment above SP
- TP at same level of SP
10
Q
Anatomic Landmarks
- sternal nocth
- sternal angle
- nipple
- inferior angle of scapula
- umbilicus
- termination of spinal cord
- illiac crest sorresponds w/
- PSIS correspons w.
A
- T2
- rib 2
- T4 dermatome
- T7
- T 10 dermatome
- L2
- L4
- S2
11
Q
Muscles of respiration
- primary
- secondary
A
- diaphragm and intercostals
- scalenes, pec minor, serratus ant
12
Q
Ribs
- typical
- atypical
- true
- false
- floating
- pump handle
- bucket handle
- caliper
A
- 3-10
- 1,2,11,12
- 1-7
- 8-10
- 11-12
- 1-5
- 6-10
- 11-12
13
Q
Rib dysfunction
- Inhalation dysfunction
- Exhalation dysfunction
- Key rib
A
- ribs are restricted in exhalation
- ribs are restricted in inhalation
- BITE
14
Q
Disk herniation
- most often location
- direction
- sequalae
- sxs
- DX
- TX
A
- between L4-5
- posterior/lat
- pressure on nerve root of vert below
- pain at that vert and radiate down leg, sharp burning pain
- MRI
- No direct techniques
15
Q
Spondylolysis
- what is it
- causes
Spondylolosthesis
- what is it
- sxs
A
- defect in part interarticularis w/o ant displacement of vert body
- extension injury
- one vert body slips in relation to the one below
- back pain that radiates posteriorly to or below the knee worse with standing
- flexion exercises and observation, avoid activities that aggravate condition
16
Q
Cauda equina syndrome
- what is it
- sxs
- tx
A
- large central disc herniation compressing the sacral nerve roots
- similar to herniated disc but also include bowel and bladder dysfxn, decreased rectal tone
- emergent surgical decompression, always order STAT MRI, no OMT
17
Q
Nerve Root Dysfxn
- L4
- L5
- S1
A
- lat thigh to medial calf, no patellar reflex
- lateral thigh and calf, no dorsiflexion
- posterior thigh and calf, no plantar flexion or achilles reflex
18
Q
Standing vs seated flexion test
- what do they test
A
- Standing is a illial sacral dysfxn
- Seated is a sacral illial dysfxn, because inominates are locked when sitting
19
Q
Sacral dx
- seated flexion
- L5
- post ILA and deep sulcus
- spring/sphinx
A
- axis is on opp side of the positive side
- rotated opp for torsion
- should be opp in torsion and if on same side it is unilateral
- if + it means it is extended
20
Q
sacral torsion
- side bending
- rotation
- forward
- backward
A
- axis is on same side
- sacrum rotated to opp direction
- physiologic
- non-physiologic
21
Q
Sacral shear (unilateral sacral flexion or extension)
- deep sacral sulcus and post ILA
- seated flexion test
- L5
Bilateral Sacral flexion or extension
- flexion: superior sulci deep; lumbar curve; ILA shallow; spring/sphinx; seated flexion
- extension: superior sulci deep; lumbar curve; ILA shallow; spring/sphinx; seated flexion
A
- on same side
- on same side
- rotated opp deep sacral sulcus
- right and left sup sulci deep, increased lumbar curve, ILAs shallow bilaterally; negative spring and sphinx; negative seated flexion
- right and lef sup sulci shallow; decreased lumbar curve; ILA deep bilaterally; positive sping/sphinx; negative seated flexionb
22
Q
Thoracic Outlet Syndrome
- what is it
- sxs
A
- compression of subclavian a, v and brachial plexus
- neck pain radiating to arm
23
Q
Erb-Duchenne
- what is it
- presentation
A
- upper arm paralysis bc of injury to C5 and C6
- waiters tip
24
Q
craniosacral
- flexion
- exension
A
- counternutation (base is post), hands inferior and wider
- nuation (base is ant), hands superior and narrow
25
Osteo tx: direct vs indirect and active vs passive
- Myo release
- counterstrain
- FPR
- ME
- HVLA
- Lymph
- Cranial
- both, both
- indirect, passive
- indirect, passive
- direct, active
- direct, passive
- direct, passive
- both, passive
26
Tension headaches caused by
- capitis muscles
27
Scalenes
- ant and middle
- post
- importance
- attach to rib 1
- attach to rib 2
- brachial plexus and subclavian a lie between ant and middle scalenes
28
Spurling test
- used for
- what is it
- cervical nerve root compression
- patient seated, physician extends, side bends c spine and pushes odwnward on top of patients head
- positive if pain radiates into ipsi arm
29
Scoliosis
- most common cause
- most common curve
- tx
- idiopathic
- dextro, right shoulder forward and right scapula medial border protrudes posterior
- less than 30 observe, 30-40 is bracing, and > 40 surgery
30
Lower muscles
| - iliopsoas: function, psoas syndrome
- flexes the hip and externally rotates; pt unable to stand up straight and prefers flexed and sidebent to one side, better seated, + thomas test
-
31
Innominate Dysfunction
- ant rotation
- posterior rotation
- sup shear
- inf shear
- inflare
- outflare
- sup PUBIC shear
- Inf PUBIC shear
- ASIS inferior and medial; PSIS superior and lateral
- ASIS superior and lateral, PSIS inferior and medial
- ASIS and PSIS superior on one side
- ASIS and PSIS inferior on one side
- ASIS medial and PSIS lateral
- ASIS more lateral and PSIS more medial
- Pubic tubercle superor ipsi
- Pubic tubercle inf ipsi
32
Rotator cuff
- made up of
- most injured, positive test
- supraspinatus, infraspinatus, teres minor, subscapularis
| - supraspinatus, beer can test
33
Nerves of brachial plexus
- c5: sensation, motor, relfex
- c6: sensation, motor, relfex
- c7: sensation, motor,
- c8: sensation, motor,
- T1: sensation, motor,
- lateral arm and elbow, deltoid and bicep, biceo reflex
- lateral forearm and thumb, bicep, wrist extensor (radial N), briachioradlialis
- middle finger, wrist flexor (median N) and interossi (ulnar N)
- medial elbow and medial arm, interossi
34
Motion testing of shoulder
- apley: how? what does it mean?
- arm drop
- apprehension
- yergason
- adson
- pt attempts to reach scapula of opp shoulder; labral issue
- bring pts arm up to abduct 90 degrees and then let go to see if it drops; full rotator cuff tear
- put patients arm abducted, extended and externally rotated; pt should feel dislocation coming and become apprehensive
- physician externally rotate elbow while pt internally rotate to check if bicep tendon pops out of bicipital groove; asess stability of bicep tendon
- pt shoulder extended, externally rotated and mildly abducted while monitoring pulse and pt is asked to turn head toward side being tested and take deep breath; decreased absent or radial pulse
35
Radial Head Motion
- pronation
- supination
- guide posteriorly; falling on pronated forearm; restricted in supination freedom toward pronation
- guide anteriorly; falling on supinated forearm; restricted in pronation and freedom toward supination
36
Anatomincal snuff box
- tenderness on floor
- caused by
- imaging
- tx; consequences
- possible fracture of scaphoid
- FOOSH
- assume fracture even if not visible on xray
- thumb spica splint; avascular necrosis
37
Lateral epicondylitis vs medial
- other name
- strain
- location of pain
- test
- lateral: tennis elbow medial: golfers elbow
- lateral: extensor muscles in forearm; medial: flexor muscles in forearm
- lateral: lateral epicondyle; medial: medial epicondyle
- lateral: pt extend wrist and physician pushes against; medial: pt flex wrist
38
Forearm and Wrist complaints
- Ape hand: presentation, N affected
- Hand of benediction
- Claw hand
- wrist drop (saturday night palsy)
- waiters tip
- thenar wasting, adducted thumb, loss thumb opposition; carpal tunnel syndrome; median N at wrist
- when making fist digits 2 and 3 remain extended; median N at forearm
- pinky and ring stay bent when extended; ulnar N at wrist
- paralysis of wrist extensor; Radial N
- arm hangs at side, medial rotation; upper trunks C5-6
39
Tibiofibular joint
- pronation
- supination
- external rotation; anterior
| - internal rotation; posterior
40
Lower Nerves
- L2-4
- L4- S3
- M: quad, iliacus, sartorius, pectineus; S: anterior thigh, medial leg
- Sciatic into tibial and peroneal; tibial -> M: hamstring, plantar flexor, toe flexor; S: lower leg and plantar aspect of foot; peroneal -> M: bicep femoris, evertors and dorsiflexor of foot, extensor of toes; S: lower leg and dorsum of foot
41
Hip tests
- FABERE
- FADIR
- Ober
- Thomas
- Trendelenburg
- Straight leg
- pt supine, physician moves leg into flexion and extension; tests ROM of hip
- pt supine, physician moves leg into flexion and then adducts and internally rotates; tests ROM of hip
- pt lying on side, knee is flexed and lifted toward ceiling to let fall, look for delay; contracture of tensor fascia lata
- supine, pt asked to flex knees and hips and hug both legs, then release leg and let it fall on table, should be able to have knee lie flat on table; psoas contraction
- pt standing and lifts one leg off floor, looking for hip to drop towards side of leg picked up; assess for weak glut med
- pt supine, phsician raises patients extended leg and will have sharp shooting pain down post aspect of raised leg assess for radiculopathy,
42
Lower Nerves
- L1: motor, sensation
- L2: motor, sensation
- L3: motor, sensation
- L4: motor, reflex, sensation
- L5: motor, sensation
- S1: motor, reflex, sensation
- iliopsoas; ant thigh below inguinal ligament
- iliopsoas, adductor, quad; middle ant thigh
- adductor, quad; ant thigh above knee
- ant tibialis, patella reflex, medial malleolus
- extensor hallicus longus, quads; dorsal aspect of foot and big toe
- peroneus longus and brevis gastroc; achilles; lateral malleolus
43
Arches
- dropped cuboid
- dropped navicular
- dropped cuneiform
- medial edge glide toward plantar surface
- lateral edge glide toward plantar surface
- secon cunifrom toward plantar surface
44
Ankle sprains
- lateral stabilizers
- medial stabilizers
- grade 1
- grade 2
- grade 3
- prevent supination; anterior talofibular, calcaneifibular, posterior talofibular
- deltoid lig
- ATF, stretched or partial tear
- ATF, CFL partially teared
- complete tear of all 3
45
Cranial strains
- torsion
- sidebending-rotation
- lateral
- vertical
- compression
- rotation of base of sphenoid and occiput in opposite directions, named for higher wing of sphenoid
- sphenoid and occiput sidebend and rotate to one direction, creating convex
- lateral displacement of base of sphenoid to base of occiput and both rotate in same direction, parallelogram; named for direction of base of sphenoid
- base of sphenoid is carried superior or inferior relative to base of occiput; named for direction of base of occiput
- base sphenoid is compressed to base of occiput; amplitude is makedly decreased
46
CN somatic dysfunction and sxs
- III
- IV
- VI
- VII
- VIII
- X
- XII
- sphenobasilar, facial; dipopia, ptosis
- sphenobasilar, facial; diplopia when looking down
- sphenobasilar, facial; diplopia
- sphenobasilar, facial; sx similar to bells palsy
- sphenobasilar, temporal; tinnitus, vertigo, hearing loss
- temporal, occiput, OA; headache, arrythmia, GI upset, resp problems
- sphenobasilar, compression of condylar parts in infants
47
Sucking problems
- CN
- somatic dysfxn
- tx
- IX, X, XII
- OA, AA, C2
- OA decompression, distract occipital condyles from atlas
48
Contraindications for craniosacral tx
- absolute
- relative
- brain bleed, intracranial pressure, skull fracture
| - pts w/ seizure hx or TBI
49
Auto Innervation
- eye: parasympathetic (N and effect) vs sympathetic
- glands
- heart
- lungs
- GI
- Arteries: symp only
- GU
- Penis
- Adrenal medulla: symp only
- Liver: symp only
- CN III: constricts, T1-4: dilates
- CN VII: stimulates secretion; T1-4: vasoconstriction for slight secretion unless sweating, then increases
- CN X: decrease contractility and conduction; T1-5: increase contractility and conduction
- CN X: contracts; T2-7: dilates
- CNX: contracts SM, and increases secretion; T5-L2 relaxes lumen, contracts spincters, decreases secretion
- contracts vessels, and relaxes skeletal muscles
- S2-4: contract bladder wall and relaxes sphincter; T10-L2: contracts bladder sphincter
- S2-4: erection; T10-L2: ejaculation
- T10-L1: secrete catecholamines
- T5-9 gluconeo and glycolysis
50
Parasymp innervation
- GI
- Kidney
- repro
- upper GI w/ ascending and transverse colon is vagus while descending and rectosigmoid is pelvic splnchnic
- kidney and upper ureter is vagus, while lower urter and bladder is pelvic splanchnic
- everything is innervated by pelvis splanchnic except gonads
51
Chapmans
- appendix
- adrenals
- kidneys
- bladder
- colon
- ovaries vs uterus
- tip of R 12th rib
- 2 inches super and 1 inch lat to umbilicus
- 1 in sup and 1 inch lat from umbilicus
- at umbilicus
- along femur
- O on top of pubic symph and uterus below
52
Trigger points
| - what are they
- taught band SkM, causes referred pain
53
Counterstain
- type
- time
- ant cervical: location, tx
- post cervical: location, tx
- ant thoracic: location, tx
- post thoracic: location, tx
- indirect, fold and hold
- 90 sec
- on articular pillars; 1: away, 2-6: flexion and SARA, 7-8: flexion and STAR
- on spinous process; 2: ext; 3: flexion and SARA; 4-8: Ext SARA
- T1-6, midline sternum at attchment of rib (tx with flexion and minor rotation or sidebending) and 7-12 in rectus abdominus muscle one inch lateral to midline bilaterally (tx with flexion, STAR)
- On either side of TP ( tx with extension and SART)
54
Ant rib counter strain
- caused by
- time
- 1: location, tx
- 2: location, tx
- 3- 6: location, tx
- ant is caused by ant deperessed rib;
- 120 seconds instead of 90
- 1: below medial clavicle; F, RTST
- 2: 6-8 cm lat to sternum on rib 2; F, RTST
- 3-6: along mid axillary line of corresponding rib; F, STRT
55
Post Rib counterstain
- location
- tx
- post is caused by post depressed rib
| - 1: E, SART; 2-6: F SARA
56
Lumbar counterstrain
- Ant: location, tx
- Post
- 1: medial to ASIS, 2-4: on AIIS, 5: 1 cm lat to pubic symphysis; F, RA
- On TP; ext, SA
57
Muscle energy
| - mechanism
- golgi tendon senses increase in tension and sends impulse back to SC allowing extrafusal fibers to relax
58
Exhalation dysfxn
- rib 1: muscle affected and tx position
- rib 2
- rib 3-5
- rib 6-9
- rib 10-12
- ant and middle scalenes; pt raises head to ceiling
- post scalene; pt head rotated away and lift head to ceiling
- pec minor; pt pushes elbow of affected side toward opp ASIS
- serratus ant; push arm ant
- lat dorsi; pt adducts arm
59
Sacral muscle energy
- flexion
- extension
- pt prone, heel on ILA, follow inhale and resist exhalation
| - pt prone, heel on sacral sulcus, follow exhale resist inhale
60
Radial head ME
- posterior
- anterior
- arm is suppinated and pt asked to pronate
| - arm is pronated and pt asked to supinate
61
Cervical HVLA
- OA
- AA
- C2-C7
- cervical spine extended, rotate towards and side bend towards
- head flexed, rotate towards
- lock out neck and side bend toward
62
Thoracic HVLA
- positioning
- hands
- supine
| - thenar eminence on one TP and MCP under other TP
63
Articulatory
| - what is it
- springing technique or low velocity toward restrictive barrier with gentle repetitive forces to increase ROM
64
Articulatory
- what is it
- most common
- springing technique or low velocity toward restrictive barrier with gentle repetitive forces to increase ROM
- spencer: extension, flexion, circumduction with compression, circumduction with distraction, abduction, adduction with ex rotation, abduction with internal rotation, extension and stretching tissues
