OMM Exam 2 Flashcards
Respiratory System:
Autonomic Innervation of lung, Lymphatics of lung, Anatomic Structures of the lung, chapman’s points of the lung
Autonomic Innervation: Sympathetic is T1-T6 bilaterally. Broncho-dilation, epithelial hyperplasia with thickened secretions, VC with local hypo-perfusion.
Vagus is parasympathetic. thin secretions, bronchoconstriction.
Right lung and most of the left lung is drained by right lymphatic duct.
Anatomic: vertebrae and ribs.
Muscle: diaphragm and other respiratory muscles.
Chapman’s Points: Between 3rd and 4th rib for upper lung, between 4th and 5th rib for lower lung.
What is pathogenesis of the lung infectionS
What are Viscerosomatic components of lung function?
Infection –> irritation –> loss of surfactant–> exudate formation –> congestion, edema–> reduced pulmonary function.
They basically are the C2-C3, and T1-T6.
There are palpable muscle and joint changes.
What is the diaphragm stressed by?
Ribs and spine via viscerosomatic reflexes, tissue resistance due to congestion.
This stress produces strain of the lower 6 ribs and thoracolumbar junction–> leads to increased lumbar lordosis and flattening of the diaphragm –> decreased pressure gradient between the thoracic and abdominal cavities –> results in decreased lymph flow and increased tissue congestion.
T1-T6 paraspinal muscles will have increased tone.
OMT in pneumonia describe the goals/ techniques.benefits.
Goal: decrease the congestion by using lymphatic drainage.
Pump is CI when patient is febrile. You have to open the thoracic inlet first.
Decreasing SNS hyperactivity by treating VSR first –> rib raising, para-spinal inhibition, chapman’s points.
Normalize parasympathetic tone–> OA decompression,
Decrease mechanical impediments to thoracic cage motion
Improve Diaphragm function –> doming of the diaphragm, treating C3-C5.
OMT benefits removes waste, reduces vascular constriction, synergistic with medical therapy, improves respiration.
MOSPE Trial
Significant reductions in length of stay, duration of IV antibiotics, and respiratory failure and death when OPP is implemented
OMT and COPD
Improves RV, TLC, and pCO2 and O2 saturation.
OMT is used to improve diaphragmatic function, thoracic drainage, and chest cage motion.
OMT and Asthma:
OMT is used to treat asthma.
During attacks–> increase sympathetic tone during attacks. T1-T6 rib raising –> bronchodilation.
Between attacks: improve thoracic, sternal, costal motion
Shown to reduce length of stay, episode frequency and severity, improve peak flow.
Scoliosis definition, types, naming, severity
Lateral curvature of spine.
Types: Dextro –> rotated right, sidebent left.
Levo –>rotated left, sidebent right
Structural: does not correct with side-bending.
Functional :corrects with sidebendng
Severity:
Mild: 5-15 degrees
Moderate: 20-45 degress
Severe: > 50 degrees. >50 degrees compromises respiratory function, >75 degrees compromises cardiovascular symptoms.
Osteopathic Considerations
Body develops compensatory curves to maintain balance.
Rotation occurs into convexity. Dextro–> rotated right.
On convex side, the ribs are posterior and separate. On Concave side, ribs are closer and anterior
Disc space compression on concave side. Structural changes and growth retardation on concave side.
Scoliosis Screening
Look/feel for scioliosis.
Look for rib hump when patient bends forward.
Check for short leg.
Imaging to determine severity.
Cobb angle
<10 degrees is reevaluate in 6 - 12 months
> 10 follow up every 4- 6 months.
Treat patients whose curves progress more than 5 degrees.
Curves <20 in adult will not usually progress
What are treatment goals?
Goals: improve balance and flexibility, address the primary cause, and prevent progression and complication (fusion)
What are modalities in OMT, braces, surgery
Increase muscle balance, optimize function, treat any SD, exercise to reduce lumbosacral angle and strengthen Psoas and abdominal muscles.
Braces, Surgery if curve is >45 degrees
Short Leg Syndrome
Unlevel sacral base –> develop spinal curvature (rotoscoliosis), innominate rotation, and side shift.
When to suspect short leg syndrome
When structural asymmetry, recurrent SD, tissue texture changes
For short leg syndrome, what horizontal planes do you assess?
Mastoid process/occipital base
AC joints
Inferior angle of scapulae
Iliac crests
Greater trochanter
Short Leg Syndrome Early Compensation:
C shaped curvature is the compensation. The cephalad planes is depressed opposite to the pelvic horizontal plane.
Ex: left sacral base lowering causes there to be left sided scoliosis.
Right sides pelvic lowering, left cephalad landmrks lowering.
Late compensation
S shaped curve basically. The shoulder and greater trochanteric planes are on the same side.
Ex: left sacral base lowering causes left pelvic and left shoulder depression.
Describe the the movements of the legs, the effect on spine, effect on leg, and pain components of progressive spinal disease
Example: left sacral base turning. Left short leg, right long leg.
Left sided scoliosis. Pelvis shifts and rotates away from side of sacral base declination.
On short leg-> anterior innominate rotation.
On long leg–> posterior innominate rotation.
Long leg–> there is IR and pronation
Increase in lumbosacral angle by 2-3 degrees.
Vertebrae in most caudal scoliotic curve SB away and rotate towards the base declination.
Degenerative arthritis of the long leg.
Short leg syndrome osteopathic findings:
Somatic dysfunction.
Soft tissue involvement: tissues on the concave side shorten, while tissue on the convex side lengthen.
Tight abductors on side, tight adductor on the other side.
Ilio-lumbar ligament basically stressed on the side of the convexity–> referred pain down the testicles, labia, and upper medial thigh.
Sacroiliac ligament is stressed on the side of the convecxity, pain referral down lateral leg.
long leg–> unilateral sciatica and hip pain.
Short leg syndrome OMT Diagnosis
Look for any signs of somatic dysfunction.
Iliac crest heights, femoral head heights, sacral base unleveling, and scoliotic compensation
What is treatment for the short leg syndrome OMT wise?
<5mm not treated
If functional–> OMT
If anatomic –> do tissue realignment –> heel lift. In heel lift what you do is you basically in fragile persons life no more than 1.5 mm/2 week, while in flexible spine patients you do 1.5/week or 3mm/week.
If sudden loss of leg length–> you lift fully.
Proper lifting has been done there is no SD, negative standing flexion test, and repeat X-ray.
