OMM level 2 Flashcards
(229 cards)
1
Q
temporal and occipital bones come together to form
A
jugular foramen and occipitomastoid suture
2
Q
cranial nerves that exit the cranium through the jugular foramen
A
IX, X, and XI
3
Q
what is most sensitive for acute ACL injury
A
Lachman test, not anterior drawer
4
Q
cervical facet orientation
A
BUM
backward, upward, medial
5
Q
thoracic facet orientation
A
BUL
backward, upward, lateral
6
Q
lumbar facet orientation
A
BM
7
Q
flexion/extension
axis?
plane?
A
transvere axis
sagittal plane
8
Q
rotation
axis? plane?
A
vertical axis
transverse plane
9
Q
sidebending
axis? plane?
A
AP axis
coronal plane
10
Q
muscle contraction against resistance while forcing the muscle to lengthen
operators force is greater than pts force
A
isolytic contraction
11
Q
muscle contraction that results in the increase in tension without an approximation of origin and insertion
operator and pt force are equal
A
isometric contraction
12
Q
muscle contraction that results in the approximation of the muscle’s origin and insertion without a change in tension
operators force is less than the patient’s force
A
isotonic contraction
13
Q
myofascial release is (direct/indirect) and (active/passive)
A
both
both
14
Q
counterstrain is (direct/indirect) and (active/passive)
A
indirect
passive
15
Q
Facilitated Positional Release is (direct/indirect) and (active/passive)
A
indirect
passive
16
Q
Muscle Energey is (direct/indirect) and (active/passive)
A
direct (rarely indirect)
active
17
Q
HVLA is is (direct/indirect) and (active/passive)
A
direct
passive
18
Q
cranial is (direct/indirect) and (active/passive)
A
both
passive
19
Q
lymphatic tx is (direct/indirect) and (active/passive)
A
direct
passive
20
Q
Chapman’s reflexes is (direct/indirect) and (active/passive)
A
direct
passive
21
Q
HVLA is definitely contraindicated in
A
advanced osteoporosis and metastatic cancer
22
Q
what do you treat first, ribs or thoracics?
A
tx thoracic spine before ribs
23
Q
what might you tx before tx’ing cervical spine?
A
thoracics and ribs
24
Q
when tx’ing psoas syndrome, what do you tx first?
A
tx lumbar spine first
25
In Law I are rotation and translation in the same direction?
yes
26
is there an order to tx'ing tenderpoints?
tx most tender first
if a group of tenderpoints is there, tx middle one first and then work proximal to distal
27
In T1-T4, if you have issues, what should you be moving to induce tx?
head and neck not back
28
difficulty with hip flexion and positive thomas test
iliopsoas spasm
29
if the right hamstring is tight, what is the somatic dysfunction dx?
right hip extension somatic dysfunction
30
posterior tenderpoints are typically tx'd with
extension, sidebend away, rotate away
31
the chin will deviate to the same direction as
the OA joint rotates
32
tx of kyphosis \<50 degrees
OMM and PT
33
tx of kyphosis 50-75 degrees
bracing
34
kyphosis \>75 degrees tx
surgical fusion
35
atypical ribs
1 - only articulates with T1, no angle
2 - large tuberosity for serratus anterior
11 and 12- articulate only with corresponding vertebrae
10 - sometimes atypical
36
the upper ribs 1-5 primarily move in
pump handle motion
37
the middle ribs 6-10 primarily move in
bucket handle motion
38
the lower ribs 11-12 primarily move in
a caliper motion
39
inhalation dysfunction means
rib is stuck cephalad
40
exhalation rib dysfunction, the rib will be
held down
41
motion of L5 will influence the motion of the sacrum in two ways:
1. SB of L5 will cause a sacral oblique axis of the same side
2. rotation of L5 will cause sacrum to rotate toward the opposite side
42
grading of spondylolithesis is in what increments?
25% slippage, 1-4
43
dx spondylolisthesis with what
lateral XR
44
dx spondylolysis with
oblique XR
45
a herniated disc in the lumbar region will exert pressure on the nerve root of...
for example, L3/L4 herniation will affect the nerve root of
the vertebra below
L4
46
degenerative changes within the intervertebral disc and ankylosing of adjacent vertebral bodies is known as
spondylosis
47
pt with spondylolisthesis will have increased pain with
extension based activities
48
positive seated flexion test means
sacroiliac dysfunction on that side
49
axis for torsion is always opposite of
positive seated flexion test
| (positive R SFT = L oblique axis)
50
backward sacral torsion is when
axis and torsion are in opposite directions
51
midline bones of the cranium
sphenoid, occiput, ethmoid, and vomer
52
when flexion of the cranium occurs, where does the SBS go and what do midline bones do?
SBS moves cephalad
midline bones move into flexion
53
when the cranium is in flexion, what do the paired bones of the cranium do?
move in external rotation
54
what are the paired bones of the cranium?
frontal, temporal, and parietal bones
55
As the SBS moves cephalad, the dura pulls the sacrum into
sacral extension, aka counternutation
56
During the craniosacral flexion phase, the sacral base moves
posteriorly, into sacral extension
aka counternutation
57
During craniosacral extension phase, the sacral base moves
anteriorly, into sacral flexion/nutation
58
tx of anterior tenderpoints T1-T6
pt in flexion with arms internally rotated
59
Ribs 1-7 are
true ribs
60
ribs 8-12 are
false ribs
61
Ribs that use lats
9-10
62
Movement of the midline bones causes a .... in the AP diameter of the cranium while movement of the paired bones into external rotation cause an increase in the ..... diameter of the cranium
decrease
63
cecum viscerosomatic level
T10
64
Respiratiory and cardiovascular compromise occurs at what point in scoliosis?
50 and 75 degrees
65
tx for scoliosis based on curvature
mild 5-15 - conservative
moderate 20-45 - bracing/spinal orthotic
severe \>50 - surgery if resp. compromise or developing quickly
66
what will lumbar spine do in relation to a short leg?
sidebend away and rotate toward short leg side
67
in short leg syndrome, if the femoral head difference is greater than .... consider a ...
\>5mm, consider a heel lift
68
how do you increase heel lift?
fragile pt - 1/16 inch q 2 weeks
flexible pt - 1/8 q 2 weeks
69
what is the max height of a heel lift that can be applie inside of a shoe?
1/4 inch
70
what is the maximum heel lift possible?
1/2 inch
71
ligament from ILA to ischial tuberosity
sacrotuberous ligament
72
ligament that divides the greater and lesser sciatic foramen
sacrospinous ligament
73
one of the first ligaments to become painful in lumbosacral decompensation
iliolumbar ligament
74
muscles that make up the pelvic diaphragm
levator ani
coccygeus
75
action of piriformis
external rotation, extends thigh and abducts thigh with hip flexed
76
the innominates rotate about an .... ..... axis of the sacrum during the walking cycle
inferior transverse
77
the axis around which an innominate anterior or posterior dysfunction occurs
infererior transverse axis of the sacrum
78
during respiration, motion occurs around what axis of the sacrum?
superior transverse
79
during inhalation the sacral base will move
posterior
80
postural motion occurs about what axis of the sacrum
middle transverse
81
dynamic motion occurs during ambulation, what sacral axis does it go around?
two oblique axes
82
anterior innominate rotation is caused by
tight quads
83
posterior innominate is caused by
tight hamstrings
84
a superior pubic shear can be due to what tight muscle
rectus abdominus
85
inferior pubic shear can be due to what tight muscle
tight adductors
86
In regards to the sacrum, the positive seated flexion test will be the .... side of oblique axis
opposite
87
In sacral torsions, L5 will always rotate in the .... direction of the sacrum
opposite
88
a forward torsion will have what spring test
negative spring test
89
a bacward torsion will have what spring test?
positive spring test
90
sacral rotation on an oblique axis means L5 is
rotated to the same side as the sacrum
91
action of supraspinatus
abduction
92
action of infraspinatus
external rotation
93
action of teres minor
external rotation
94
action of subscapularis
internal rotation
95
what three places can compression for thoracic outlet syndrome occur?
between anterior and middle scalenes
between the clavicle and first rib
between the pec minor and upper ribs
96
winging of the scapula is from what nerve injury
long thoracic nerve injury
97
biceps is innervated by ....
while supinator is innervated by...
musculocutaneous
radial
98
what are the pronators of the forearm and what is their innervation?
pronator teres and pronator quadratus
innervated by the median nerve
99
muscles of the thenar eminence are innervated by the ... except for...
median n
except for adductor pollicis brevis - ulnar nerve
100
interossi are innervated by the
ulnar n
101
the flexor digitorum profundus attaches to the
DIP
102
carrying angle of \<3 degrees at the elbow is called
adduction of the ulna
cubitis varus
103
an increase in the carrying angle (abduction at the ulna) will cause an
adduction at the wrist
104
decreasing the carrying angle (adduction of the ulna) will cause
abduction of the wrist
105
carrying angle increased, what happens to ulna? what happens to wrist?
abduction of the ulna
adduction of the wrist
106
what happens if there is decreased carrying angle
ulna and wrist
adduction of ulna
abduction wrist
107
contracture of the intrinsic muscles of the hand, associated with RA
swan neck deformity
flexed MCP and DIP
extended PIP
108
results from a rupture of the hood of the extensor tendon at the PIP, associated with RA
Boutonniere deformity
extension MCP and DIP
flexion of the PIP
109
ape hand results from what nerve damages
median nerve damage
110
contracture of the last two digits with atrophy of the hypothenar eminence due to ulnar nerve damage
bishops deformity
111
which way will the head of the femur glide with external rotation of the hip
anterior
112
which way will the head of the femur glide with internal rotation of the hip?
posteriorly
113
hip is restricted in internal rotation, what is tight?
piriformis or iliopsoas spasm
114
three things that make up pronation of the ankle
dorsiflexion, eversion, abduction
115
three things that make up supination of the ankle
plantarflexion, inversion, and adduction
116
femoral nerve innervates what muscles
quads, iliacus, sartorius, pectineus
117
head and neck of femur angle \< 120
coxa vara
118
head and neck of femur angle \>135
coxa valga
119
intersection of a line from ASIS through the middle of the patella and a line from the tibial tubercle through the middle of the patella
Q angle
120
how is the talus rotated in posterior fibular head
internally rotated
121
how is talus rotated in anterior fibular head
externally rotated
122
strong vastus lateralis and weak vastus medialis - patella deviating laterally
patello femoral syndrome
123
tx patello femoral syndrome
strengthen vastus medialis
124
what is the most often affected compartment of the lower leg?
anterior compartment
125
how does the talus glide with plantarflexion
anterior
126
talocalcaneal joint acts mostly as a
shock absorber
allows internal and external rotation of the leg while the foot is fixed
127
somatic dysfunction usually occurs in which arch?
transverse arch
navicular, cuboid, or cuneiforms displace
often in long distance runners
128
ligament that strengthens and supports the medial longitudinal arch
spring ligament
129
chronic irritation to the plantar aponeurosis/fascia may cause
calcium to be laid down along the lines of stress, leading to a heel spur
130
what is normal CRI
10-14 cycles per minute
131
what would decrease the rate and quality of CRI?
stress
depression
chronic fatigue
chronic infections
132
what will increase the CRI?
vigorous physical exercise
systemic fever
following cranial OMT
133
what four things happen in craniosacral flexion
1. flexion of the midline bones
2. sacral base posterior/counternutation
3. decreased AP diameter of the cranium
4. external rotation of paired bones
134
what four things happen in craniosacral extension?
1. extension of the midline bones
2. sacral base anterior/nutation
3. Increased AP diameter of the cranium
4. internal rotation of the paired bones
135
name craniosacral flexion and extension for the direction of
sphenoid movement
136
What are physiological cranial strains?
F/E
torsion
Sb/Ro
137
What are nonphysiologic strains?
vertical strain
lateral strain
compression
138
torsion
sphenoid and occiput rotate in opposite directions around 1 AP axis
139
sidebending and ro
sphenoid and occiput move opposite directions around 2 vertical axes
move the same direction around 1 AP axis
140
what motion is in vertical strain
sphenoid deviates cephalad or caudad to the occiput
2 parallel transverse axes
141
flexion
two transvere axes, opposite rotation s and o
142
lateral strain
2 vertical axes
same direction
143
compression
1 AP axis
144
placement of vault hold
index finger - greater wing sphenoid
middle finger - temporal bone
ring finger - mastoid region of temporal bone
little finger - squamous portion of the occiput
145
venous sinus technique is aka
spreading sutures,
to increase venous flow so that blood may exit the skull through the jugular foramen
146
what does CV4 technique do?
increase amplitude of CRI
147
absolute contraindications to cranial OMM
acute intracranial bleed, increase ICP, skull fx
148
T1-T4
head and neck
149
T1-T5
heart
150
T2-T7
respiratory system
151
T2-T8
esophagus
152
T5-T9
upper GI
stomach, liver, GB, spleen, portions pancreas and duodenum
153
T10-T11
middle GI tract
portions pancr and duodenum, jejunum, ileum, ascending colon and prox 2/3 transverse colon
154
T12-L2 GI
Lower GI tract
distal 1/3 transverse colon, descedning colon and sigmoid, rectum
155
T12
appendix
156
kidneys
T10-11
157
adrenal medulla
T10
158
upper ureters
T10-11
159
lower ureters
T12-L1
160
bladder
T11-L2
161
gonads
T10-T11
162
uterus and cervix
T10-L2
163
erectile tissue of penis and clitoris
T11-L2
164
prostate
T12-L2
165
arms
T2-T8
166
Legs
T11-L2
167
purposes of rib raising
normalize/decrease sympathetic activity
improve lymphatic return
encourage max inhalation and provokes a more effective negative intrathoracic pressure
168
purpose of celiac ganglion, superior mesenteric, inferior mesenteric releases
normalize/decrease sympathetic activity
169
purpose of sphenopalatine ganglion technique
enhance parasympathetic acitivity to encourage thin watery secretions
170
manipulation of OA, AA or C2 joints will influence
parasympathetic tone via the vagus nerve
171
posterior chapman appendix
TP of T11
172
myofascial release procedure
1. palpate restriction
2. apply compression (indirect) or traction (direct)
3. add twisting or transverse forces
4. use enhancers
5. await release
173
goal of myofascial release
restore functional balance to all integrative tissues and improve lymphatic flow
174
common compensatory pattern
OA left
CT right
TC left
LS right
175
lymphatic drainage of the right/minor duct usually drains into the
R brachiocephalic vein
or R IJ and subclavian veins
176
the lymphatic drainage of the Left/major duct drains to
the junction of the L IJ and subclavian veins
177
order of lymphatic tx
thoracic inlet
rib raising or paraspinal inhibition
redome the thoracoabdominal diaphragm
apply lymphatic pump techniques
178
anterior cervical tenderpoints
located anterior to or on most lateral aspect of lateral masses
Sa Ra
179
Ant C7 tenderpoint
2-3 cm lateral to the medial end of the clavicle, at attachment of SCM
F St Ra
180
posterior cervical tenderpoints
tip of spinous process or on the lateral sides of the spinous process
E S(slightly)a Ra
181
inion tenderpoint
at the posterior occipital protuberance or right below
marked flexion
182
Post C3 tenderpoint on C2
F Sa Ra
183
anterior T1-T6 tenderpoints
midline of sternum at the attachment of corresponding ribs
flex thorax and add small Sa Ra
184
anterior T7-T12 tenderpoints
in the rectus abdominis muscle about one inch lateral to the midline on R or L
flex thorax and Sa Ra
185
posterior thoracic tenderpoints
either side of spinous process or TP
E Sa Ra
186
anterior rib tenderpoints are associated with
depressed ribs/ exhaled ribs/ exhalation dysfunction/ inhalation restriction
187
posterior rib tenderpoints are associated with
elevated ribs/inhalation ribs/inhalation dysfunction/ or an exhalation restriction
188
Rib 1 and 2 tenderpoints
1 - just below medial end of clavicle
2 - 6-8 cm lateral to the sternum on rib 2
Flex head, St Rt
189
ribs 3-6 tenderpoints
located on the mid axillary line on the corresponding rib
slight flexion, St Rt
190
posterior rib tenderpoints
angle of the corresponding rib
minimal flexion, Sa Ra
191
anterior L1 tenderpoint
medial to ASIS
pt supine, knees and hips flexed, marked Ra
192
anterior L2-L4 tenderpoints
AIIS (L2 medial, L3 lateral, L4 inf)
supine, knees and hips flexed, Ra
193
anterior L5 tenderpoint
lateral to pubic symphysis on superior ramus
supine, knees and hips flexed and Ra
194
posterior lumbar tenderpoints
either side of spinous process or on TP
L3 and L4 may be iliac crest
L5 on PSIS
prone, extended and Sa (R t or a)
195
lower pole L5 tenderpoint
caudad to PSIS
prone, hip and knee flexed, leg internally rotated and adducted
196
iliacus tenderpoint
7 cm medial to ASIS
supine, hip flexed and externally rotated
197
piriformis tenderpoint
piriformis muscle
prone, hip and knee flexed, thigh abducted and externally rotated
198
facilitated positional release procedure
1. flatten the curves of the spine
2. apply facilitating force (compression or torsion)
3. shortens muscle to be tx'd
4. hold for 3-4 seconds
5. release the position and reevaluate
199
supine position, doc flexes pt neck, holding it for 10 seconds, then extends the neck and holds for 10 seconds... etc
positive test if pt complains of dizziness, visual changes, lightheadedness, or nystagmus occurs
Wallenbergs test
for vertebral artery insufficiency
200
arm extended at the elbow, shoulder extended, externally rotated, and slight abducted - monitor pulse in wrist - take a deep breath and turn head toward ipsilateral arm
Adson test
thoracic outlet syndrome 2/2 tight scalenes
201
hyperabducting the arm above the head with some extension - monitor pulse
Wrights test
thoracic outlet syndrome due to compression under pec minor at coracoid process
202
palpate the radial pulse while depressing and extending the shoulder
costoclavicular syndrome test
thoracic outlet obstruction due to compression between clavicle and first rib
203
apleys scratch tests for
abduction and ext ro when reaching behind head
adduction and internal rotation when reaching behind back
204
assess the biceps tendon in the bicipital groove - pt fully extends elbow, flexes the shoulder and supinates the forearm; physician resists flexion of the shoulder
speeds test
205
determines the stability of the biceps tendon in the bicipital groove - flexes elbow to 90 while doc grasps elbow with one hand and wrist with other; while pulling down on elbow, doc externally rotates the forearm as the pt resists this motion
Yergasons test
206
assess adequacy of blood supply to the hand
Allens test
207
to test for tenosynovitis
finkelstein test
208
flexion of wrist for one minute
phalens test for carpal tunnel
209
purpose of hip drop test
evaluate sidebending (lateral flexion) of the lumbar spine
210
straight leg test is aka
lasegues test
211
straight leg test caused pain, so I am bringing the leg just down and dorsiflexing the foot
Braggards test
to stretch sciatic nerve - with pain now, means sciatic origin
212
positive ASIS compression test means dysfunction of the
sacrum, innominates, or pubes
213
test to determine if sacrum is midline
pelvic shift test
214
pt standing, doc stabilizes shoulders with the R hand pushes the pelvis to the R with the L hand; then translate the opposite way
pelvic shift test
positive test to the side of freer translation, meaning the pelvis is shifted to that side
215
when would I see a pelvic shift?
flexion contracture of iliopsosas (psoas sydnrome)
216
A flexion contracture of the R iliopsoas will cause a positive pelvic shift to the
left
217
assess gluteus medius muscle strength
trendelenberg test
218
the lumbosacral spring test will be positive in all the dysfunctions in which
the sacral base moves posterior
219
lumbosacral spring test is positive when
little to no springing- indicative of sacral base posterior
220
if the physicians hands become more symmetric with lumbar extension,
part of the sacral base moved anterior
221
FABERE tests for
hip or SI joint dysfunction
222
pt is supine and doc flexes knee and hip
thomas test
iliopsoas spasm, CL leg comes up
223
test evaluates problems with full knee extension, usually due to meniscal tears or joint effusions;
pt is supine, doc grabs heel, knee is flexed completely, then knee is allowed to drop into extension
bounce home test
normally, the knee should 'bounce home' into full extension to a sharp end-point, without restriction
positive test if extension is incomplete or there is a 'rubbery' feel to the end point extension
224
apley compression and distraction on the knee while pt is prone
meniscus if pain while compression
MCL or LCL if pain with distraction and roation
225
McMurray, external rotation of tibia with valgus stress
posterior tear medial mensicus
226
McMurray, internal rotation with varus stress on knee
posterior aspect of lateral meniscus
227
pull patella distal and ask pt to contract quad
patellar grind test
assess the posterior articular surfaces of the patella and possibility of chondromalacia patellae
228
test used to assess medial and lateral ligaments of the ankle
anterior drawer test of the ankle
229
draw out chapmans points
cool pic/labels
