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OMM IV Final Flashcards

1
Q

Pregnancy: Physiologic adaptations of pregnancy include changes in posture. kWhich of the following is a postural change?

a. head forward
b. rounded shoulders
c. increased lumbar lordosis
d. center of gravity shifts

A

all of the above

  • hyperextended knees
  • pronated feet
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2
Q

Pregnancy: During the 1st trimester, there are changes in circulation and fluids including:

  1. Total body water increases (6-8 liters)
  2. Hemodilution of RBC (physiologic anemia)
  3. Cardiac output increases by 10 weeks (reaches max levels by 20-24 weeks)

Treatment considerations should include addressing lymphatic function and removal of restrictions. What are examples?

A

thoracic and pelvic diaphragms should operate in harmony to achieve optimal function of the thoracic diaphragm and lymphatic pump

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3
Q

Pregnancy: Hormonal changes associated with 1st trimester include:

  1. progesterone
  2. 17-hydroxyprogesterone
  3. estradiol
  4. relaxin

It is important to consider pre-existing somatic dysfunction and to address nausea/vomiting. What are conservative treatment considerations?

A
  1. Focused OMT
    - -T5-T9, diaphragm, thoracic cage, mediastinal tension, thoracic and abdominal viscera and rib mechanicsm
  2. Treat Viscerosomatics
    - -CHapman, Cranial, Vitamin B
    - -delayed release doxylamine and pyridoxine
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4
Q

Pregnancy: What are the sympathetic innervations of the

  1. Uterus and Cervix
  2. Gonads
  3. Vagina, Clitoris, Penis
  4. Prostate
A
  1. Uterus and Cervix
    - -T10-L2
    - -constricts uterine fundus, relaxes cervix
  2. Gonads
    - -T9-T11
  3. Vagina, Clitoris, Penis
    - -T11-L2
    - -inc. vascular constriction, ejaculation
  4. Prostate
    - -L1-L2
    - -contraction
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5
Q

Pregnancy: What are the parasympathetic innervations of the

  1. Ovaries, Testes
  2. Uterus, Prostate
  3. Vagina, Clitoris, Penis
A
  1. Ovaries, TEstes
    - -Vagus
  2. Uterus, Prostate
    - -Pelvic splanchnic (S2-S4)
    - -relaxes uterine fundus
    - -constricts cervix
  3. Vagina, Clitoris, Penis
    - -erection of penis, clitoris
    - -inc. glandular secretion in vagina
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6
Q

Pregnancy: During the 2nd trimester the uterus rises out of the pelvis and reaches midway between the pubic bone and umbilicus (by week 16).

What could be used to treat a patient with prior conditions (painful stretching of adhesions)?

A

MFR and visceral manipulation

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7
Q

Pregnancy: During the 2nd trimester the uterus rises out of the pelvis and reaches midway between the pubic bone and umbilicus (by week 16).

What could be used to treat a patient with round ligament pain?

A

anterior counterstrain treatment L3-L5

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8
Q

Pregnancy: Pregnancy: During the 2nd trimester the uterus rises out of the pelvis and reaches midway between the pubic bone and umbilicus (by week 16).

What could be used to treat a patient with shortness of breath?

A

rib raising, rib/thoracic MFR release, doming of the diaphragm

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9
Q

Pregnancy: Carpal tunnel syndrome can develop in the 2nd trimester in patients with excessive edema or fluid retention. It virtually always resolves following delivery (may linger if breastfeeding).

What are treatment options?

A
  1. Nighttime splinting
  2. OMT for 6 weeks
    - -neck, upper back, shoulder, thoracic inlet…
    - -MFR, ME, HVLA, articulation
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10
Q

Pregnancy: Women often develop low back pain during pregnancy due to changes in the center of gravity and increased stress of tissue on the lumbar spine and pelvic ligaments.

Treatment options may include:
MFR, ME, HVLA, articulation.

What is important to consider in cases of low back pain?

A

positioning (modify positions to accomodate the enlarging abdomen

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11
Q

Pregnancy: In the 3rd trimester, there are increased effects of gravity on the uterus leading to abdominal fascial drag on inguinal tissues. In addition, women often experience constipation, edema, hemorrhoids and inc. pelvic pressure.

What are methods of treatment?

A
  1. Constipation
    - -Tx pelvic diaphragm
  2. Edema
    - -lymphatic Tx, thoracics, MFR, soft tissue to mobilize fluids
  3. Hemorrhoids
    - -Tx improved lymphatic and venous drainage and balance pelvic floor tensions
  4. Pelvic pressure
    - -ishcial tuberosity spread may aid hemorrhoids and pelvic pressure
  5. Reflux
    - -mid-thoracic spine
    - -Chapman’s, viscerosomatics
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12
Q

Pregnancy: Which of the following is a warning sign and indication for referral?

a. severe pain that interferes with function (non-positional persistent back pain at night)
b. inc. pain with cough, sneezing, valsalva
c. sudden bladder incontinence or bowel incontinence
d. neurologic deficits (weakness, sensory deficit, abnormal reflexes)

A

all of the above

  • immunosuppressive therapy
  • women at risk for compression fracture **
  • systemic systems such as fever, chills weight loss

**send for immediate evaluation at ED or appropriate clinician

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13
Q

Pregnancy: Post-partum changes include pubic dysfunction (forces of labor on the pubic symphysis lead to inc. risk of postpartum somatic dysfunction).

True/False - It is common to see women with vertical, anterior or posterior shears, and pubic symphysis diaphysis. They may also present with hand and wrist complains, low back pain, and breast engorgement/mastitits.

A

True

*pseudosciatica

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14
Q

Pregnancy: Which of the following is an indication for OMT during pregnancy?

a. somatic dysfunction
b. scoliosois or structural conditions
c. edema
d. congestion

A

all

*any condition amenable to OMT

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15
Q

Pregnancy: Which of the following is a contraindication of OMT in pregnancy?

a. undiagnosed vaginal bleeding
b. incomplete abortion
c. ectopic
d. placenta previa

A

all of the above

*abruption, pretrum rupture of membranes, preterm labor (relative contraindication), prolapsed umbilical cord, eclampsia and severe preeclampsia, surgical/medical emergencies

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16
Q

Pregnancy: The _______ study was a randomized placebo-controlled trial whose objective was to evaluate the efficacy of OMT on

  1. low back pain
  2. improve function in 3rd trimester
  3. improve selected outcomes of labor and delivery (length, fever, need to forceps, Apgar)

400 women in their 3rd trimester were divided into 3 groups: Usual Care Only (UCO), UCO + OMT, UCO + placebo (ultrasound). They received 7 treatments over nine weeks.

A

PROMOTE

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17
Q

Pregnancy: True/False - The PROMOTE study revealed that high-risk status was less likely to develop in participants who received OMT. Furthermore, the OMT protocol did NOT inc. risk of precipitous labor, operative vaginal delivery, C-section…etc.

A

True

  • UCO group: worsening pain and functioning
  • prolonged labor with OMT group
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18
Q

Pregnancy: In the PROMOTE study, the PUT (placebo ultrasound) group addressed the same regions as the OMT group using an ultrasound wand (with no waves). What were the results in the PUT groups?

A
  • therapeutic response due to repetitive pressure from wand + friction/skin contact (light myofascial)
  • dec. pain in pregnancy
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19
Q

Pregnancy: True/False - When using high risk status and L and D outcomes an an index for safety, there was no greater risk in the OMT group was found. Futhermore, there was a trend toward a mild protective effect of the OMT protocol on the development of high risk status.

This trend indicates that OMT is a SAFE intervention during the 3rd trimester

A

True

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20
Q

Gyn: _______ is painful menstruation (primary or secondary). If primary, it usually appears within 6-12 months of menarche and may be due to

  1. uterine contractions or ischemia
  2. psychological factors
  3. cervical factors (cervical stenosis)
A

Dysmenorrhea

Secondary:
–endometriosis, kpelvic inflammation, fibroids, adenomyosis, ovarian cysts, pelvic congestion

Tx:
-NSAIDS, contraception, CCB, progestogens, GnRH agonists

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21
Q

Gyn: True/False - If patient fails to respond to medical and/or OMT, it is possible a secondary cause of dysmenorrhea

A

True

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22
Q

Gyn: OMT for dysmenorrhea may include addressing

  1. Pelvic pain
  2. Edema
  3. Self-treatment

What are treatment methods for pelvic pain?

A
  1. Chapmans’ (IT band)
  2. T10-L2 somatic dysfunction (sympathetics)
  3. S2-S4 (parasympathetics)
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23
Q

Gyn: OMT for dysmenorrhea may include addressing

  1. Pelvic pain
  2. Edema
  3. Self-treatment

What are treatment methods for edema?

A
  1. abdominal diaphragm
  2. thoracic inlet
  3. lower extremities

*self-treatment: knee-chest position (lift uterus out of the pelvis)

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24
Q

Gyn: If a patient fails to respond to medical and/or OMT, consideration should be given to a secondary cause of dysmenorrhea. Secondary dysmenorrhea is not limited to menstrual pain and is less related to the 1st day of bleeding. It often develops in women 20-30 years of age.

What are associated symptoms of 2ndary dysmenorrhea?

a. dyspareunia
b. infertility
c. abnormal bleeing
d. sweating

A

A-C

*managed by Tx underlying cause, somatic dysfxn

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25
Q

Gyn: Chronic pelvic pain may be due to multiple etiologies including endometriosis, adhesions, urologic (cystitis) and Crohn’s. It may also be associated with Psych issues (Depression, trauma), and/or somatic dysfunction.

It is difficult to treat and may require surgery, medication, counseling and OMT. What are OMT treatment options for patients with CPP?

A 
LIPLSIP
S/CS (pelvis, sacrum, lumbar)
Pelvic diaphragm release
Lumbopelvic release
Lumbosacral decompression
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26
Q

Gyn: WHich of the following is an absolute contraindication to OMT in a gynecology patient?

a. surgical emergency
b. undiagnosed bleeding
c. lack of informed consent
d. cancer

A

A and B

Medicolegal:
–lack informed consent (language)

Relative:

  • -bone fragility (NO HVLA)
  • -cancer

Caution:
–very ill patients (only Tx for brief periods)

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27
Q

Facilitated positional release: ___________ techniques are techniques involving positioning of the joint or tissue AWAY from a barrier and toward a relative ease or freedom of motion. They allow neural mechanisms or fascial tension to be altered to permit improvement inmotion of the joint or tissue.

A

Indirect techniques

  • affects muscle spindle
  • passive
  • approprioate for acute injury, frail or sick px
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28
Q

FPR: Types of Indirect techniques include:

  1. MFR (direct or indirect)
  2. Soft tissue (indirect/direct)
  3. Facilitated positional release (FPR)
  4. Balanced ligamentous tension and Ligamentous articular strain
  5. Cranial (indirect/direct)

______ involves flattening of the AP curve and applying an activating force (compression). The patient is placed into position of freedom (diagnosis) for 3-5 sec and then returned to neutral

A

Facilitated positional release

*remove activating force after return to neutral

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29
Q

FPR: Types of Indirect techniques include:

  1. MFR (direct or indirect)
  2. Soft tissue (indirect/direct)
  3. Facilitated positional release (FPR)
  4. Balanced ligamentous tension and Ligamentous articular strain
  5. Cranial (indirect/direct)

_____ occurs when the joint/tissue is placed in a point of balance until release is appreciated.

A

BLT and LAS

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30
Q

FPR: ________ is a system of indirect MFR treatment developed by Stanley Schiowitz. The component region of the body is placed into a neutral position, diminishing tissue and joint tension in all plances and an activating force (compression or torsion) is added.

A

FPR

*goal = dec. abnormal muscle hypertonicity (superficial and deep) and restore lost motion

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31
Q

FPR: Accurate DIAGNOSIS is necessary for successful FPR treatment, as it focuses on treating the muscular and articular dysfunction.

What are indications of FPR?

a. muscle hypertonicity
b. articular somatic dysfunction
c. acute and chronic dysfunction
d. malignancy

A

A-C

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32
Q

FPR: Which of the following is an absolute Cx of FPR?

a. absence of somatic dysfunction
b. lack of patient consent/cooperation
c. fracture
d. joint instability

A

A-C

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33
Q

FPR: Which of the following is an relative Cx of FPR?

a. herniated disk
b. vertebral artery disease
c. severe osteoporosis
d. joint instability

A

all of the above

  • strain/sprain
  • foraminal stenosis
34
Q

FPR: Diagnosis involves evaluation for muscle ______. Afterward, you evaluate for segmental somatic dysfunction (I or II) and then follow TART.

A

hypertonicity

35
Q

FPR: To treat muscle hypertonicity, the A-P spinal curve must be flattened or neutralized before a facilitating force is applied. This may be done by

A

compression, torsion or combo of both

  1. then place patient’s muscles in relaxed position (position of ease)
  2. hold position 3-5 sec
36
Q

FPR: To treat intervertebral motion restrictions, the AP curve must again be flattened before the facilitating force can be applied.

How does the second step differ from treatment of muscle hypertonicity?

A

place vertebra into position that allows freedom of motion in ALL planes

37
Q

FPR: True/False - Facilitated positional release is believed to help restore muscle spindle output, as it is believed that shortening the muscle more than intended initially leads to decreased muscle spindle ouput.

A

True

38
Q

FPR: _______ is an osteopathic method of treatment that involves minimization of periarticular tissue load and places the affected ligaments in a position of equal tension in all appropriate planes so that the body’s inherent forces can resolve the somatic dysfunction

A

Balanced ligamentous tension and ligamentous articular strain

**Tx ligaments around joint

39
Q

FPR: In a normal joint the tension in all ligaments is balanced and is used to center adjacent bones in the articular grooves and spaces. This keeps the bones from being jammed too close together or pulled too far apart.

True/False - The motion mechanics between the bones of a joint are the result of a change in the shape of the joint space, not because one set of ligaments because taut or another becomes lax

A

True

  • ligaments maintain a constant level of tension, do not stretch or become lax
  • injury: bone jammed beyond its physiologic position leading to ligament strain
40
Q

FPR: True/False - The goal of BLT/LAS is an indirect (balance) technique used to balance the tension in both ligaments and to maintain equal tension until the body re-centers the bones (by tightening the lax ligament). Ligament can then heal

A

True

  • passive motion to anatomic barrier
  • active motion to restrictive barrier

*watch lecture

41
Q

FPR: The 3 main steps of BLT/LAS are:

  1. Disengage
  2. Exaggerate
  3. Balance

____ involves compression or decompression, increasing pressure or traction until the injured part can be moved. In other words, position the dysfunctional segment in relation to the segment below.

A

Disengage

42
Q

FPR: The 3 main steps of BLT/LAS are:

  1. Disengage
  2. Exaggerate
  3. Balance

_____ involves carrying the injured part back to the original position of injury by rotating, flexing, extending or sidebending until a balance point is reached. ALL planes of motion of the joint should be addressed and balanced.

A

Exaggerate

*balance point = wobble point

43
Q

FPR: The 3 main steps of BLT/LAS are:

  1. Disengage
  2. Exaggerate
  3. Balance

_____ involves maintaining the dysfunction in the position of injury (indirect position) until a release of the tissue occurs

A

Balance

*respiration use to find balance point

44
Q

FPR: Which of the following describes the difference between BLT and LAS?

a. BLT uses a lighter force and more respiratory cooperation
b. LAS uses high forces (e.g. 40lbs) whereas forces used in BLT are only ~ 1-3 lbs
c. Only BLT is used to balance ligamentous structures

A

A and B

45
Q

FPR: What are contraindications to BLT/LAS?

a. fracture or dislocation
b. ligamentous rupture or tear
c. severe osteoporosis
d. positioning causes other symptoms to appear

A

all of the above

46
Q

TOS: _______ is a group of syndromes characterized by impingement of nerves or vascular structures at the thoracic outlet. It leads to symptoms in the upper extremity and neck.

It is 90% neurogenic and 1% arterial.

Diagnosis is clinical and PE

A

Thoracic Outlet syndrome (TOS)

47
Q

TOS: A patient presents with pain in her arms and occasionally her neck. She reports pain is worse at rest. She admits to weakness, fatigue and parasthesia (ulnar esp.)

On PE you note edema (1% with venous). Vascular changes are present (changes in pulse). You suspect

A

TOS

*interscalene triangle, costoclavicular space, subpectoral tunnel

48
Q

TOS: What are triggers of TOS?

a. Trauma
b. Prolonged, repeated overhead activities
c. Weight lifting
d. Anomalous or cervical rib

A

all of the above

  • trauma: clavicle fracture, whiplash
  • posture: hunched over
  • cervical ribs: bilateral > 50% of time
  • congenital/acquired clavicle deformity
49
Q

TOS: A patient presents with complaints of parasthesia of her left arm (medial aspect C8-T1 distribution). She reports pain and weakness. She also admits to HA.

On PE you note weakness (atrophy). Patient is positive for Raynaud (hypersympathetic vasoconstriction). Cervical rib is present.

PMH: Neck trauma due to repetitive stress

You suspect

A

Neurogenic TOS

  • brachial plexus compression
  • cervical rib often
50
Q

TOS: A patient presents with ischemia of the digits, pallor, coldness and hand pain.

On PE you note parasthesia, and claudication.

PMH significant for emboli.

You suspect

A

Arterial TOS

  • emboli, subclvian artery stenosis, aneurysms
  • cervical rib or 1st rib anomaly

*NO inciting incident on Hx

51
Q

TOS: A patient presents with swelling of the arm, cyanosis, and pain (dec. blood from subclavian).

Patient is an avid swimmer, and admits to constant “over head” activity of his arms when swimming.

A

Venous TOS

  • Paget Schroetter syndrome
  • rowing, wrestling, weight lifting,

Dx: US +/- venography
Manage: anticoagulation, catheter-thrombolysis, surgery

52
Q

TOS: Clinical variations of TOS include:

  1. Anterior Scalene syndrome
  2. Cervical rib syndrome
  3. Costoclavicular syndrome
  4. Hyperabduction syndrome

______ involves the subclavian artery and the brachial plexus. It is inc. with muscle hypertrophy, and affects the interscalene triangle. Diagnosis via Adson’s test.

A

ANterior scalene syndrome

  • Adson:
  • -inc. tension in scalenes, narrows triangle
  • -monitor radial pulse, patient extends neck and rotates toward (reproduce pain, dec. pulse)
53
Q

TOS: Clinical variations of TOS include:

  1. Anterior Scalene syndrome
  2. Cervical rib syndrome
  3. Costoclavicular syndrome
  4. Hyperabduction syndrome

______ involves the subclavian artery MORE OFTEN than the brachial plexus. It is associated with cervical rib. Diagnosis via modified Adson’s test (px turns head away).

A

Cervical rib syndrome

Adson modified:
–px turns head to contralateral side, holds inhalation

54
Q

TOS: TOS: Clinical variations of TOS include:

  1. Anterior Scalene syndrome
  2. Cervical rib syndrome
  3. Costoclavicular syndrome
  4. Hyperabduction syndrome

______ involves both the subclavian artery and vein. It MC occurs due to narrowing of the space bewteen the clavicle and the 1st rib. Diagnose via Military posture (costoclavicular maneuver)

A

Costoclavicular syndrome

*monitor radial pulse - push down on and extend shoulder (back) – check for diminished pulse

55
Q

TOS: TOS: Clinical variations of TOS include:

  1. Anterior Scalene syndrome
  2. Cervical rib syndrome
  3. Costoclavicular syndrome
  4. Hyperabduction syndrome

_____ involves the neurovascular bundle and mainly involves the pectoralis minor (ribs 3-5; attaches to coracoid). Diagnosis via hyperabduction test (Wright’s)

A

Hyperabduction syndrome

*monitor radial pulse – hyperabduct patient’s shoulder (above head) – pain and dec. pulse

56
Q

TOS: The ______ indicates compression of the brachial plexus.

  1. Abduct arms to 90 degrees with straight elbows (sx should be ipsilateral)
  2. Dorsiflex wrists (symptoms should be ipsilateral)
  3. Sidebend head to one side and then other (symptoms should be contralateral to SB side)
    * check for pain radiating down arm/parasthesias
A

Upper limb tension test

  1. Ipsilateral (abduct)
  2. Ipsilateral (dorsiflex)
  3. Contralateral w/ SB
57
Q

TOS: The ______ stress test is another test used for NTOS and involves abduction of the shoulders w/ 90 degree external rotation. Elbows flex 90 degrees and patient alternately opens and closes their hands.

A

Elevated arm stress test

*check for reproduction of pain/parasthesia within 60 seconds

(“hands up under arrest pose)

58
Q

TOS: TOS is often associated with somatic dysfunctions including:

  1. Cervical spine (C3-C6, top of rib 1)
  2. Ribs 1-3 (inhaled)
  3. Upper thoracics
  4. Scapula/Clavicle

Lifestyle changes and ergonomics may be recommended, along with stretches and PT.

A

True

59
Q

TOS: A patient presents with complaints of weakened grip strength and atrophy of the thenar eminence. He reports pain and parasthesia in the first 3 fingers along the distribution of the median nerve. Symptoms worse when sleeping (hand flexed), and with repetitive motions of the wrist. He admits symptoms improve with shaking his hand/wrist or changing positions.

On PE you note dec. sensation in the first 3 fingers and weakness of the thenar eminence. (+) Phalen’s, (+) Tinel’s. Capillary refill and pulses normal

SH: He is a construction worker and admits to exposure to constant vibratory forces and repetitive movements.

A

Carpal tunnel syndrome

*also pregnancy, hypothyroidism, DM, RA, obesity

  • compressed median nerve (inc. fluid in carpal tunnel)
  • LOAF (1st and 2nd lumbricals, opponens policis, abductor pollicis brevis, flexor pollicis brevis)
60
Q

TOS: Treatment of Carpal Tunnel syndrome includes:

  1. OMT
  2. Stretches
  3. Ergonimics
  4. Lifestyle changes
  5. NSAIDS
  6. Splints
  7. Surgery

Surgery involves the release of

A

flexor retinaculum

*scar tissue buildup

OMT: thoracics, ribs, radial head, carpal tunnel stretches

61
Q

Postural balance: For an adult population with previous multi-regional chronic pain, use of a _____ to level the sacral base is followed by alleviation of ~70% of the # of regions with pain.

Anecdotally, where there is correction of BOTH feet and ankles, standing and seated, > 90% of the number of regions with chronic pain are alleviated.

A

heel lift

*reduce chronic pain by leveling the standing pelvis

62
Q

Postural balance: Where foot orthotics are prescribed, re-film with the orthotics in place and re-measure the unlevelness of the sacral base.

  1. Where the initial unlevelness is 1/16th inch, add ______ heel lift.
  2. Where the initial unlevelness is > 1/18 inch, add ______.
A
  1. 1/16th
  2. 1/8th
    - -start with 1/8th, slowly add over time

*each 2 weeks after the initial lift, add 1/16th inch

63
Q

Lab: List the steps you need to take for shoulder pain

A
  1. Special tests
    - -Neer, Drop arm
  2. Test passive/Active motion
    - -patient watches and follows
  3. Screen Cervicals and Thoracics
    - -global
  4. Screen SC, AC
    - -review treatments
  5. Screen ribs

**Describe TART findings

  1. Exercise recommendations
    - -Wall crawl (improves flexibility, restores balance)
  • Treat with ME, Still,
  • Direct Technique and Indirect technique
64
Q

Psoas: Thomas test is a positive test when there is increased _______ or patient’s leg rises off the table

A

lumbar lordosis

65
Q

Lab: List the steps you need to take to treat psoas syndrome

A
  1. Special tests
    - -Thomas Test
    - -Trendelenburg
  2. Lumbars
  3. Shears (inominate and pubic)
    - -Compression test
    - -PSIS, Iliac crest, ASIS, pubic tubercle
  4. Sacrum
    - -seated flexion
    - -ILA and ______
    - -check L5
  • ***Describe TART findings
  • **Can treat psoas Counterstrain point: SB Toward, Rotate Away
  1. Exercise recommendations
    - –psoas lunge (improves hip mobility and muscle stregnth)
66
Q

Lab: List the steps you need to take to treat low back pain (in pregnancy)

A
  1. Special tests
    - -Straight leg raise
    - -Braggard
  2. Lumbars
  3. Innominate Shears, Rotations
  4. Pubic shears
  5. Sacrum

Treatments:
–Cat and Camel or Childs pose
(mobilize spine, stretches core muscles, Inc. circulation and eases low back pain)

67
Q

Lab: List the steps you need to take to treat thoracic outlet syndrome

A
  1. Special tests
    - -Adson’s and Wright’s
  2. Test passive/Active motion
    - -patient watches and follows
  3. Screen Cervicals and Thoracics
    - -global
  4. Screen SC, AC
    - -review treatments
  5. Screen ribs

**Describe TART findings

  1. Exercise recommendations
    - -Wall crawl (improves flexibility, restores balance)
68
Q

Lab: List the steps you need to take for shoulder pain

A
  1. Special tests
    - -Neer, Drop arm
  2. Test passive/Active motion
    - -patient watches and follows
  3. Screen Cervicals and Thoracics
    - -global
  4. Screen SC, AC
    - -review treatments
  5. Screen ribs

**Describe TART findings

  1. Exercise recommendations
    - -Wall crawl (improves flexibility, restores balance)
    - -Pec stretch
  • Treat with ME, Still,
  • Direct Technique and Indirect technique
69
Q

Review:

  • -SC, AC muscle energy
  • -review pelvic Tx
  • -review sacrum treatment
A

ignore

70
Q

LIPLSIP

A 
Lower extremity
Innominate shears
Pubic shears
Lumbar
Sacrum 
Innominate
Psoas
71
Q

Scoliosis: _____ is defined as lateral curvature of the spine > 10 degrees. Greater than 10 degrees visible

A

Scoliosis

72
Q

Scoliosis: _____ are reversible curves, meaning they can reduce or disappear

A

Functional curves

73
Q

Scoliosis: _______ are fixed curves, meaning they cannot reduce or disappear

A

Structural

74
Q

Scoliosis: Severity

  1. Mild
  2. Moderate
  3. Severe
A
  1. 5-15 degrees
  2. 20-45
  3. > 50 degrees

*degree of severity determined by Cobb angle (measure on X-ray)

75
Q

Scoliosis: Idopathic classification: Adolescent (> 10 years to skeletal maturity) is MC. It usally appears in early adolescence and prevalence is based on the Cobb angle.

Who is more likely to require treatment?

A

Females (7x more likely)

*typically no pain in adolescence

76
Q

Scoliosis: Idiopathic scoliosis is a diagnosis of exclusion. You must rule out secondary causes.

On physical exam, the curve is visible at ____ degrees

A

10 degrees

77
Q

Scoliosis: ______ (Adam’s test) is the most specific special test for scoliosis. A positive test is a sign of asymmetry of the rib cage (rib hump - thoracic; paraspinal muscle masses - lumbar).

A

Forward bending test

78
Q

Scoliosis: Naming the curbe is based on

  1. Direction of curve
  2. Type of curve
  3. Identified by certevbral apex, vertebrae involved
A
  1. Direction:
    - -convexity of the curve
  2. Type of Curve
    - -based on apex
  3. Identified by
    - -vertebral apex, vertebra involved
79
Q

Scoliosis: The angle made by the line drawn along the superior end plate of the upper vertebrae in the curve and inferior end plate of lowest vertebrae in the curve

A

Cobb angle

80
Q

Scoliosis: Osteopathic Management involves optimizing

A

mobility and function

*postural lifting for short leg syndrome

OMM (11 decks)

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